Collaborative care for primary care treatment of late‐life depression in Singapore: Randomized controlled trial

• Published in: International journal of geriatric psychiatry Vol. 35; no. 10; pp. 1171 - 1180
• Main Authors: Ng, Tze Pin, Nyunt, Ma S. Z., Feng, Liang, Kumar, Rajeev, Fones, Calvin S. L., Ko, Soo Meng
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Inc 01-10-2020; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Collaboration; collaborative care; Delivery of Health Care; depression; Depression - therapy; elderly; Geriatric psychiatry; Humans; Mental depression; Primary care; Primary Health Care; Quality of Life; Remission; Singapore; Treatment Outcome; Singapore; primary care; depression; collaborative care; elderly
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.5353

Background
The effectiveness and portability of the collaborative care model in the primary care treatment of depression has not been demonstrated in many randomized controlled trials in healthcare settings across the world. We determined the effectiveness of collaborative care management of elderly depression in the primary care setting in Singapore.
Method
Eligible participants with depressive symptoms were randomized to 6‐month duration usual care (UC, N = 112) or collaborative care (CC, N = 102). Outcome measures were HDRS‐17, GDS, BDI and SF‐12 MCS QOL measured at 3, 6, and 12‐month, care satisfaction at 6‐month, and also measured on 120 participants who refused referral (non‐receipt of care, NC). Primary outcome was HDRS‐17 measure of depression severity, response and remission at 6‐month.
Results
HDRS scores in CC group compared to UC group were reduced more at 6‐month (1.5 points difference in change from baseline), and also at 3 and 12‐month, with similar observations of differences for GDS and BDI. There was significantly greater improvement for both CC and UC groups compared to NC group. The CC group was about 1.5 times more likely to show HDRS treatment response and remission, and more than two times likely to show GDS treatment response and remission than the UC and NC groups, as well as better quality of life improvement (P < .001) and better care satisfaction (P < .001).
Conclusion
Collaborative care is effective for primary care treatment of older persons with depression and is portable in diverse health care settings.