HOME HELP FEEDBACK SUBSCRIPTIONS ALL ISSUES SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hegel, M. T. Articles by Lin, E. H.B. Search for Related Content PubMed PubMed Citation Articles by Hegel, M. T. Articles by Lin, E. H.B.

Impact of Comorbid Panic and Posttraumatic Stress Disorder on Outcomes of Collaborative Care for Late-Life Depression in Primary Care

Received December 9, 2003; revised May 27, July 9, 2004; accepted July 23, 2004. From the Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, CA. Send correspondence and reprint requests to Dr. Hegel, Department of Psychiatry, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. e-mail: mark.hegel{at}dartmouth.edu
© 2005 American Association for Geriatric Psychiatry

Objective: Comorbid anxiety disorders may result in worse depression treatment outcomes. The authors evaluated the effect of comorbid panic disorder and posttraumatic stress disorder (PTSD) on response to a collaborative-care intervention for late-life depression in primary care. Methods: A total of 1,801 older adults with depression were randomized to a collaborative-care depression treatment model versus usual care and assessed at baseline, 3, 6, and 12 months, comparing differences among participants with comorbid panic disorder (N=262) and PTSD (N=191) and those without such comorbid anxiety disorders. Results: At baseline, patients with comorbid anxiety reported higher levels of psychiatric and medical illness, greater functional impairment, and lower quality of life. Participants without comorbid anxiety who received collaborative care had early and lasting improvements in depression compared with those in usual care. Participants with comorbid panic disorder showed similar outcomes, whereas those with comorbid PTSD showed a more delayed response, requiring 12 months of intervention to show a significant effect. At 12 months, however, outcomes were comparable. Interactions of intervention status by comorbid PTSD or panic disorder were not statistically significant, suggesting that the collaborative-care model performed significantly better than usual care in depressed older adults both with and without comorbid anxiety. Conclusions: Collaborative care is more effective than usual care for depressed older adults with and without comorbid panic disorder and PTSD, although a sustained treatment response was slower to emerge for participants with PTSD. Intensive and prolonged follow-up may be needed for depressed older adults with comorbid PTSD.

Key Words: Anxiety Disorders • Physical Comorbidity • Depression • PTSD • Panic Disorder

This article has been cited by other articles:

				B. Trappler, C. I. Cohen, and R. Tulloo Impact of Early Lifetime Trauma in Later Life: Depression Among Holocaust Survivors 60 Years After the Liberation of Auschwitz Am J Geriatr Psychiatry, January 1, 2007; 15(1): 79 - 83. [Abstract] [Full Text] [PDF]

				D. Mittal, J. C. Fortney, J. M. Pyne, M. J. Edlund, and J. L. Wetherell Impact of Comorbid Anxiety Disorders on Health-Related Quality of Life Among Patients With Major Depressive Disorder Psychiatr Serv, December 1, 2006; 57(12): 1731 - 1737. [Abstract] [Full Text] [PDF]

				M. Silverstein, M. Augustyn, H. Cabral, and B. Zuckerman Maternal Depression and Violence Exposure: Double Jeopardy for Child School Functioning Pediatrics, September 1, 2006; 118(3): e792 - e800. [Abstract] [Full Text] [PDF]

				A. Y. Dombrovski, R. E. Blakesley-Ball, B. H. Mulsant, S. Mazumdar, P. R. Houck, K. Szanto, and C. F. Reynolds III Speed of Improvement in Sleep Disturbance and Anxiety Compared With Core Mood Symptoms During Acute Treatment of Depression in Old Age. Am J Geriatr Psychiatry, June 1, 2006; 14(6): 550 - 554. [Abstract] [Full Text] [PDF]

				H. Burroughs, K. Lovell, M. Morley, R. Baldwin, A. Burns, and C. Chew-Graham 'Justifiable depression': how primary care professionals and patients view late-life depression? a qualitative study Fam. Pract., June 1, 2006; 23(3): 369 - 377. [Abstract] [Full Text] [PDF]

				A. J. Flint Anxiety and Its Disorders in Late Life: Moving the Field Forward Am J Geriatr Psychiatry, January 1, 2005; 13(1): 3 - 6. [Full Text] [PDF]