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ABSTRACT: Objective
We developed a personalized intervention for depressed patients with COPD (PID-C) aimed to mobilize patients to participate in the care of both conditions. We showed that PID-C reduced depressive symptoms and dyspnea-related disability more than usual care over 28 weeks. This study focused on untangling key therapeutic ingredients of PID-C.Design
Randomized controlled trial.Setting
Community.Participants
138 patients who received the diagnoses of COPD and major depression after screening 898 consecutive admissions for acute inpatient pulmonary rehabilitation.Intervention
Nine sessions of PID-C compared with usual care over 28 weeks.Measurements
Primary outcome measures were the 17-item Hamilton Depression Rating Scale and the Pulmonary Functional Status and Dyspnea Questionnaire-Modified. Other measures were adherence to rehabilitation exercise (≥2 hours per week) and adherence to adequate antidepressant prescriptions.Results
Low severity of dyspnea-related disability and adherence to antidepressants predicted subsequent improvement of depression. Exercise and low depression severity predicted improvement of dyspnea-related disability.Conclusions
PID-C led to an interacting spiral of improvement in both depression and disability in a gravely medically ill population with a 17% mortality rate over 28 weeks and an expected deterioration in disability. The interrelationship of the course of depression and dyspnea-related disability underscores the need to target adherence to both antidepressants and chronic obstructive pulmonary disease rehabilitation. PID-C may serve as a care management model for depressed persons suffering from medical illnesses with a deteriorating course.
SUBMITTER: Alexopoulos GS
PROVIDER: S-EPMC3923856 | biostudies-literature | 2014 Nov
REPOSITORIES: biostudies-literature
Alexopoulos George S GS Kiosses Dimitris N DN Sirey Jo Anne JA Kanellopoulos Dora D Seirup Joanna K JK Novitch Richard S RS Ghosh Samiran S Banerjee Samprit S Raue Patrick J PJ
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20130814 11
<h4>Objective</h4>We developed a personalized intervention for depressed patients with COPD (PID-C) aimed to mobilize patients to participate in the care of both conditions. We showed that PID-C reduced depressive symptoms and dyspnea-related disability more than usual care over 28 weeks. This study focused on untangling key therapeutic ingredients of PID-C.<h4>Design</h4>Randomized controlled trial.<h4>Setting</h4>Community.<h4>Participants</h4>138 patients who received the diagnoses of COPD an ...[more]