Poststroke depression is a prevalent and disabling disorder, yet evidence regarding the effectiveness of treating poststroke depression is inconclusive. Our objective was to determine the effectiveness of the Activate-Initiate-Monitor care management program for the treatment of poststroke depression.
We conducted a prospective, randomized, outcome-blinded trial in 188 ischemic stroke survivors identified at the time of admission to one of 4 Indianapolis hospitals. Depression screening and enrollment occurred between 1 and 2 months poststroke. The Activate-Initiate-Monitor intervention was a care management program that included Activation of the patient to recognize depression symptoms and accept treatment, Initiation of an antidepressant medication, and Monitoring and adjusting treatment. Usual care subjects received nondepression-related education and were prescribed antidepressants at the discretion of their provider. The primary outcome measure was depression response, defined as a Hamilton Depression Inventory score <8 (remission) or a decrease from baseline of at least 50% at 12 weeks.
Intervention and usual care groups did not differ on any key baseline measures. Both depression response (51% versus 30%, P=0.005) and remission (39% versus 23%, P=0.01) were more likely in the Activate-Initiate-Monitor intervention than in the usual care group. This difference in depression scores was present by 6 weeks and persisted through the 12-week assessment. Serious adverse events did not differ between the 2 groups.
The Activate-Initiate-Monitor care management model is significantly more effective than usual care in improving depression outcomes in patients with poststroke depression.
"imary care , med - ical specialty care , and geriatric health care can be an effective strategy for identifying and treating suicidal older people with physical conditions ( Alexopoulos et al . , 2009 ; Bensadon , 2015 ; Erlangsen et al . , 2011 ; Gallo et al . , 2013 ; Lindner , Foerster , & von Renteln - Kruse , 2013 ; Un€ utzer et al . , 2006 ; Williams et al . , 2007 ) . There is also a need for integrating mental health care and palliative care ( Kasl - Godley , King , & Quill , 2014 ) . Collaborative care models typically involve the following components : ( 1 ) improving routine screening and diagnosis of depres - sive disorders ; ( 2 ) increasing provider use of evidence - based protocols for th"
[Show abstract][Hide abstract] ABSTRACT: Objectives:
To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older.
Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review.
Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed.
Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.
Aging and Mental Health 09/2015; DOI:10.1080/13607863.2015.1083945 · 1.75 Impact Factor
"& Boren, 2000; Institute of Medicine & Committee on Quality of Health Care In America, 2001) Randomized clinical trials demonstrate the effectiveness of collaborative care in improving outcomes for older adults with depression, dementia, and other chronic medical and mental health conditions.(Bruce et al., 2004; Callahan et al., 2006; Counsell et al., 2007; Gilbody, Bower, Fletcher, Richards, & Sutton, 2006; Institute of Medicine, Committee on the Future Health Care Workforce for Older Americans, & Board on Health Care Services, 2008; Kroenke et al., 2007; Magnabosco, 2006; Unutzer et al., 2002; Vickrey et al., 2006; Williams et al., 2007) Despite the effectiveness of these new models of care, there are multiple barriers to their widespread adoption, and most older adults with mental illness do not have access to these interventions. (Boustani, Sachs, & Callahan, 2007; Institute of Medicine et al., 2008) While translational research seeks to overcome barriers between " bench to bedside " and between " bedside to clinical care " , there is also a translation gap between clinical care in the research setting and clinical care in actual community practice.(Westfall, "
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression.
Capitalizing on the substantial interest in the US on the patient-centered medical home concept, the Aging Brain Care Medical Home targets older adults with dementia and/or late-life depression in the primary care setting. We describe a structured set of activities that laid the foundation for a new partnership with the primary care practice and the lessons learned in implementing this new care model. We also provide a description of the core components of this innovative memory care program.
Findings from three recent randomized clinical trials provided the rationale and basic components for implementing the new memory care program. We used the reflective adaptive process as a relationship building framework that recognizes primary care practices as complex adaptive systems. This framework allows for local adaptation of the protocols and procedures developed in the clinical trials. Tailored care for individual patients is facilitated through a care manager working in collaboration with a primary care physician and supported by specialists in a memory care clinic as well as by information technology resources.
We have successfully overcome many system-level barriers in implementing a collaborative care program for dementia and depression in primary care. Spontaneous adoption of new models of care is unlikely without specific attention to the complexities and resource constraints of health care systems.
Aging and Mental Health 10/2010; 15(1):5-12. DOI:10.1080/13607861003801052 · 1.75 Impact Factor
"While pathophysiological processes of stroke may contribute to post-stroke depression (Lyketsos et al., 1998), non-pharmacological interventions may play an important role in its treatment (Hibbard et al., 1990)),(Watzlawick and Coyne, 1980). Recently, an RCT showed that a care management program resulted in higher remission rates than usual care in stroke survivors with major or minor depression (Williams et al., 2007); the intervention helped patients to recognize depression and accept treatment, offered an antidepressant, and monitored and adjusted treatment. These findings serve as a signal of the potential value of psychosocial interventions. "
[Show abstract][Hide abstract] ABSTRACT: To serve as a conceptual map of the role of new interventions designed to reduce the burden of late-life depression.
We identified three needs to be addressed by intervention research: (1) the need for novel interventions given that the existing treatments leave many older adults depressed and disabled; (2) the need for procedures enabling community-based agencies to offer interventions of known efficacy with fidelity; and (3) the need to increase access of depressed older adults to care.
Our model orders novel interventions according to their role in serving depressed older adults and according to their position in the efficacy, effectiveness, implementation, and dissemination testing continuum. We describe three interventions designed by our institute to exemplify intervention research at different level of the model. A common element is that each intervention personalizes care both at the level of the individuals served and the level of community agencies providing care. To this end, each intervention is designed to accommodate the strengths and limitations of both patients and agencies and introduces changes in the patients' environment and community agencies needed in order to assimilate the new intervention.
We suggest that this model provides conceptual guidance on how to shorten the testing cycle and bring urgently needed novel treatments and implementation approaches to the community. While replication studies are important, propose that most of the support should be directed to those projects that take rational risks, and after adequate preliminary evidence, make the next step along the testing continuum.
International Journal of Geriatric Psychiatry 12/2009; 24(12):1325-34. DOI:10.1002/gps.2287 · 2.87 Impact Factor
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