Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 261
Appendix A
Improving Recognition and Quality
of Depression Care in Patients with
Common Chronic Medical Illnesses
Wayne J. Katon, M.D.1
INTRODUCTION
Delay of harmful effects of growing older has been called “compression
of morbidity” (Fries, 1980), “successful aging” (Rowe and Kahn, 1987),
and “healthy aging” (Guralnik and Kaplan, 1989). Both health promotion
activities and enhanced management of chronic conditions have been sug-
gested as ways to improve successful or healthy aging (Von Korff et al.,
2011). Health promotion activities, such as exercise, healthy diet, weight
loss, and cessation of smoking, are believed to potentially enhance success-
ful aging. Given the high prevalence of chronic illness in aging populations,
improving guideline-based management of the most common chronic ill-
nesses, such as diabetes, heart disease, asthma and chronic obstructive pul-
monary disease (COPD), cancer, and depression, would also have a major
public health impact in improving successful aging (Mor, 2005). Depres-
sion is unique in that it is as common in the general population as these
other chronic conditions but also occurs in high prevalence as a comorbid
condition (Katon, 2011). Effective treatment of comorbid depression has
been found to reduce functional impairment in patients with diabetes (Ell
et al., 2010; Williams et al., 2004), heart disease (Lesperance et al., 2007;
Rollman et al., 2009), arthritis (Lin et al., 2003), and chronic pain (Kroenke
et al., 2009). However, there are major gaps in the recognition and quality
1 Professor and Vice-Chair, Department of Psychiatry & Behavioral Sciences, Box 356560,
University of Washington School of Medicine, Seattle, Washington.
261
OCR for page 262
262 LIVING WELL WITH CHRONIC ILLNESS
of treatment of depression in aging populations with chronic medical illness
(Katon et al., 2004a).
Patients with chronic medical illness have been found to have two- to
threefold higher rates of major depression compared with age- and gender-
matched primary care controls (Katon, 2011). Rates of depression among
primary care patients are between 5 and 10 percent (Katon and Schulberg,
1992), whereas prevalence rates of depression in patients with chronic
medical illnesses, such as diabetes and coronary artery disease, have been
estimated to be 12 to 18 percent (Ali et al., 2006) and 18 to 23 percent,
respectively (Schleifer et al., 1989; Spijkerman et al., 2005). Rates of de-
pression in complex multicondition aging populations may be as high as
25 percent (McCall et al., 2002).
Studies have suggested that there is a bidirectional relationship between
depression and such chronic medical illnesses as diabetes, heart disease, and
COPD (Figure A-1) (Katon, 2011). Depression often develops in the teen-
age years or early adulthood. Predisposing factors to depression include ge-
netic factors as well as experiencing childhood adversities, such as the loss
of one or both parents, neglect, and abuse (Kendler et al., 2002). Stressful
life events in people with these vulnerabilities often precipitate depressive
episodes (Caspi et al., 2003). Exposure to childhood adversity also often
leads to problems with maladaptive attachment patterns in adult relation-
ships, resulting in lack of social support and problems with interpersonal
relationships (Bifulco et al., 2002). Lack of support and interpersonal prob-
lems may precipitate and prolong depressive episodes (Bifulco et al., 2002).
Depression in adolescence and early adulthood is associated with three
health behaviors that have been estimated to cause 40 percent of premature
mortality in the United States: obesity, smoking, and sedentary lifestyle
(Katon et al., 2010c). Psychobiological changes that have been shown to
be associated with depression, such as increased cortisol levels, sympathetic
nervous system dysregulation, and increased proinflammatory factors, are
likely to add to maladaptive health factors in increasing the risk of prema-
ture development of chronic illness (Katon, 2011).
Once chronic illness develops, comorbid depression is associated with
poor self-care (DiMatteo et al., 2000; Lin et al., 2004) and increased risk
of adverse outcomes (Lin et al., 2009; van Melle et al., 2004). As Figure
A-1 shows, patients with comorbid depression and chronic medical illness
often have problems collaborating with physicians and are less likely to
adhere to self-care regimens (diet, cessation of smoking, exercise, and tak-
ing medications as prescribed) (Katon, 2011). These maladaptive patterns
lead to a higher risk of medical complications, increased symptom burden,
and worsening function, which can then in turn precipitate or worsen de-
pressive episodes.
Extensive epidemiological data have shown that, after controlling for
OCR for page 263
FIGURE A-1 Bidirectional interaction between depression and chronic medical disorders.
SOURCE: Adapted and reprinted from Biological Pyschiatry, 54, Wayne J. Katon, Clinical health services and relationship between
A-1.eps
major depression, depressive symptoms, and general medical illness, 216–226, 2003, with permission from Elsevier.
263
bitmap, landscape
OCR for page 264
264 LIVING WELL WITH CHRONIC ILLNESS
sociodemographic factors and severity of medical illness, patients with
comorbid depression and chronic medical illnesses, such as diabetes, coro-
nary heart disease (CHD), COPD/asthma, and cancer, also have a higher
medical symptom burden (Katon et al., 2007), additive functional impair-
ment (Von Korff et al., 2005), higher medical costs (Simon et al., 2005;
Sullivan et al., 2002), increased complication and hospitalization rates
(Davydow et al., 2011; Lin et al., 2010; van Melle, et al., 2004), and in-
creased mortality (Egede et al., 2005; Katon et al., 2005b; Lin et al., 2009,
2010; van Melle et al., 2004; Zhang et al., 2005). Figure A-2 describes the
results of comorbid depression on diabetes symptom burden from a 5-year
prospective study of approximately 4,800 predominately type 2 diabetes
patients enrolled in a large health care system in Washington state. After
controlling for sociodemographic factors and severity of medical illness,
comorbid major depression in these patients was a stronger predictor of
10 symptoms on a diabetes symptom scale than was number of diabetes
complications or HbA1c level (Ludman et al., 2004). In addition, in this
cohort of approximately 4,800 patients with diabetes, comorbid depression
was associated with more than additive functional impairment (Von Korff
et al., 2005), and approximately 50 to 70 percent higher medical costs
(Simon et al., 2005). Over the 5-year period, after controlling for socio-
demographic factors and the baseline severity of medical illness, patients
with comorbid depression and diabetes compared with those with diabetes
alone had a 24 percent greater risk of macrovascular complications (Lin
et al., 2010), a 36 percent greater risk of microvascular complications
(Lin et al., 2010), a twofold increased risk of incident foot ulcers (Williams
et al., 2010), a twofold increased risk of dementia (Katon et al., 2010b),
and a 50 percent greater risk of mortality (Katon et al., 2005b; Lin et al.,
2009), as seen in Table A-1.
In considering ways to improve diagnosis and treatment of people with
depression and chronic illnesses, it is important to recognize that these are
often aging populations. The prevalence of chronic medical illness increases
with each decade of life, and approximately 40 percent of Medicare benefi-
ciaries have two or more chronic medical illnesses (Hoffman et al., 1996).
Aging populations with depression have been found to be significantly less
likely to utilize mental health services compared with younger depressed
patients (Unützer et al., 2000). This is likely to be due to increased stigma
regarding mental illness in aging populations, less access due to insurance
issues (i.e., many private mental health specialists do not accept Medicare
payments), decreased mobility due to chronic medical illnesses and func-
tional decline, and less knowledge about mental illness in this population
(Unützer et al., 2000; Van Citters and Bartels, 2004). Among the patients
whose depression is recognized in primary care, few receive guideline-level
pharmacotherapy or psychotherapy (Druss, 2004; Katon et al., 2004a).
OCR for page 265
265
APPENDIX A
FIGURE A-2 Relationship of depression and diabetes symptoms.
SOURCE: Ludman et al., 2004.
OCR for page 266
266 LIVING WELL WITH CHRONIC ILLNESS
TABLE A-1 Relationship of Depression and Diabetes Symptoms
Minor Depression Major Depression
Microvascular Complications 1.05 (0.83, 1.33) 1.33 (1.08, 1.65)
Macrovascular Complications 1.32 (0.99, 1.75) 1.38 (1.08, 1.78)
Mortality (All Cause[s]) 1.23 (0.94, 1.61) 1.53 (1.19, 1.96)
Foot Ulcers 1.32 (0.74, 2.35) 1.99 (1.22, 3.24)
Dementia — 2.69 (1.77, 4.07)
SOURCE: Katon, 2011.
PUBLIC HEALTH PLATFORMS TO
ENHANCE CARE OF DEPRESSION
Given the high prevalence of depression in patients with chronic medi-
cal illness and the decreased likelihood of accessing mental health services,
it is important to consider possible “public health platforms” that could
improve the likelihood of accurate diagnosis and treatment of people with
depression and chronic medical illness.
Because of the lack of access to traditional mental health services in
aging medically ill populations, several recent reports have advocated either
developing community-based outreach mental services for frail elderly with
multiple chronic illnesses or integrating mental health services into primary
care. These recent publications include the surgeon general’s report on men-
tal health (HHS, 1999), the report by the Administration on Aging (2001),
and the summary of the subcommittee of the President’s New Freedom
Commission on Mental Health (Bartels, 2003).
COMMUNITY-BASED PUBLIC HEALTH PLATFORMS
A recent meta-analysis that evaluated face-to-face psychological ser-
vices for adults ages 65 and older with mental illness identified 14 studies,
including 5 randomized controlled trials (Van Citters and Bartels, 2004).
An interesting finding from this systematic review compared studies that
used “gatekeeper models” of recruitment, such as meter readers, building
supervisors, or utility workers, with those using medical or social work
personnel. Those using gatekeepers tended to identify more socially isolated
elderly, such as those living alone and people more often widowed or di-
vorced (Van Citters and Bartels, 2004). However, individuals identified by
either gatekeepers or medical/mental health personnel had similar mental
and physical health services needs.
Of the 14 studies reviewed in this meta-analysis, 2 found support for
using gatekeepers, such as utility workers, to identify socially isolated ag-
OCR for page 267
267
APPENDIX A
ing populations with mental illness (Florio and Raschko, 1998; Florio et
al., 1998). Other researchers are piloting work with community-based
organizations to educate and screen populations for depression, such as
churches or adult day care centers (Chung et al., 2010). In all, 12 studies
(of which only 5 were randomized controlled trials) found that home- and
community-based treatment of psychiatric symptoms were associated with
improved psychological status (Van Citters and Bartels, 2004). All five
randomized trials (and a more recent sixth trial) reported home-based
interventions were associated with improved depressive symptoms, and one
reported improved overall psychological symptoms (Banerjee et al., 1996;
Blanchard et al., 2002; Ciechanowski et al., 2004; Llewellyn-Jones et al.,
1999; Rabins et al., 2000). This review will focus on the evidence from
the randomized controlled trials, which focused on depression in socially
isolated, often medically frail elderly.
Many communities have developed visiting home-based services for
aging patients with disabilities that limit mobility. These services are often
provided by either social workers or nurses. These frail elderly have been
found to have a high prevalence of major depression due to social isola-
tion, chronic pain, and lack of access to medical and mental health services
(McCall et al., 2002).
Research has shown that depression screening that is connected to
an organized treatment program, increasing exposure to evidenced-based
depression treatment, can significantly improve outcomes of these patients
(Banerjee et al., 1996; Blanchard et al., 2002; Ciechanowski et al., 2004;
Llewellyn-Jones et al., 1999; Rabins et al., 2000).
A recent study randomized 138 patients ages 60 and over with minor
depression or dysthmia to the Program to Encourage Active, Rewarding
Lives for Seniors (PEARLS) or usual care (Ciechanowski et al., 2004).
The PEARLS intervention consisted of problem-solving treatment, social
and physical activation, and potential recommendations to patients’ physi-
cians regarding antidepressant medications (Ciechanowski et al., 2004).
The intervention was provided by social workers who were supervised by
psychiatrists employed by Aging and Disability Services, a county-funded
home visiting program for frail elderly. Social workers screened clients
with the Patient Health Questionnaire-2 (PHQ-2) during routine in-home
visits or during telephone calls. Positive scores then led to screening with a
structured psychiatric interview, and clients with either minor depression or
dysthmia were offered randomization to the study intervention compared
with usual care. This intervention significantly increased the percentage
of patients with at least a 50 percent decrease in depressive symptoms or
remission of depressive symptoms (Ciechanowski et al., 2004). Intervention
patients compared with usual care controls also were found to have greater
improvement in health-related quality of life and emotional well-being.
OCR for page 268
268 LIVING WELL WITH CHRONIC ILLNESS
This home-based PEARLS program was also recently tested in 80
patients with comorbid depression and epilepsy (Ciechanowski et al.,
2010). Patients with epilepsy have extremely high rates of depression and
markedly higher rates of suicide compared with other medical populations
(Ciechanowski et al., 2010). The PEARLS intervention was delivered by
master’s-level counselors and compared with usual primary care and was
found to significantly decrease depressive symptoms and suicidality over a
12-month period (Ciechanowski et al., 2010).
Rabins et al., examined in a randomized controlled trial the effect of
a multidisciplinary care protocol and nurse-based outreach to 298 seniors
living in public housing (Rabins et al., 2000). Among the six housing sites,
residents in three buildings were randomized to receive the intervention
and three buildings were randomized to usual care. The intervention group
had significantly more improvement in overall general psychological symp-
toms as well as depression symptoms compared with controls (Rabins et
al., 2000). The intervention had two key components: (1) identification of
potential patients by gatekeepers (managers, social workers, janitors) and
(2) evaluation and treatment by a psychiatric nurse supervised by a psychia-
trist. A limitation of this protocol was the lack of a standardized treatment.
Llewellyn-Jones and colleagues examined the effect of a multidisci-
plinary treatment program provided primarily by a general practitioner
in 220 elderly people living in a residential facility (Llewellyn-Jones et al.,
1999). The intervention group had significantly greater improvement in de-
pressive symptoms compared with controls (Llewellyn-Jones et al., 1999).
The shared care intervention program involved multidisciplinary consulta-
tion and collaboration, training of several practitioners and caretakers in
detection and management of depression, and depression-related health
education and activity programs for residents. The control group received
routine care.
Blanchard and colleagues tested a screening and multidisciplinary mul-
timodal intervention in 96 elderly people living at home with minor or
major depression (Blanchard et al., 2002). The intervention involved a
psychiatrist interview, presentation of results to a multidisciplinary geriatric
psychiatry team, and a nurse interventionist working closely with a general
practitioner to implement recommendations made by the team (Blanchard
et al., 2002). Controls received standard or usual care. The intervention
group showed greater improvement in depressive symptoms than controls
at 3 months. Limitations include lack of control for baseline factors and a
lag between initial assessment and the start of the intervention.
Banerjee and colleagues tested a home-based intervention for depres-
sion with 69 people ages 65 and over who received home care and were de-
pressed (Banerjee et al., 1996). Members of the intervention group received
a package of care that was developed by a community psychogeriatric team
OCR for page 269
269
APPENDIX A
and implemented by one psychiatrist. Controls received care as usual by
a general practitioner. Patients in the intervention group were significantly
more likely to have recovered from depression at 6 months compared with
controls (Banerjee et al., 1996).
The home-based programs for frail elderly that utilized nurses as case
managers and/or geriatric multidisciplinary teams often also evaluated
medical conditions and geriatric risk factors, such as potential for falls and
poor nutrition.
PRIMARY CARE PLATFORMS
Large observational studies have found that severity of medical illness
was a predictor of chronicity of depression symptoms in aging popula-
tions with chronic medical illness (Kennedy et al., 1991). Therefore, a key
research question is whether evidenced-based psychotherapeutic and phar-
macological treatment approaches that have been found to be efficacious
in depressed patients without chronic medical illness would be as effective
in those with depression and comorbid conditions, such as diabetes, CHD,
or cancer.
Several systematic reviews have found that antidepressants are more
effective than placebo in patients with depression and chronic medical ill-
ness (Gill and Hatcher 2000; van der Feltz-Cornelis et al., 2010). Systematic
reviews have also found that evidence-based psychotherapies, such as cog-
nitive behavioral therapy, were more effective than supportive, nonspecific
theories in treatment of depression in patients with comorbid medical ill-
ness (van der Feltz-Cornelis et al., 2010). Most of these trials of antidepres-
sant medication or psychotherapy were small, with fewer than 100 patients,
and they often selected patients with less severe medical illness and limited
psychiatric comorbidities (Gill and Hatcher, 2000; van der Feltz-Cornelis
et al., 2010).
A key question has been how to deliver evidence-based depression
treatment to the large populations of patients with chronic conditions
across a range of severity. Since most patients with comorbid depression
and chronic medical illness are seen by primary care physicians and/or
medical specialists, integrating depression services into these systems of
care is a logical way to deliver mental health services to larger populations.
Collaborative care models have been shown to be effective in improv-
ing the quality of depression care and depression outcomes compared with
usual primary care in a wide range of primary care populations, from
adolescent (Asarnow et al., 2005) through geriatric populations (Unützer
et al., 2002). Collaborative care programs integrate an allied health pro-
fessional, such as a nurse or social worker, into primary care to support
behavioral and pharmacological treatments initiated by primary care pro-
OCR for page 270
270 LIVING WELL WITH CHRONIC ILLNESS
viders (Gilbody et al., 2006). These allied health professionals are trained
to provide patient education about common mental disorders, proactively
track clinical symptoms using such rating scales as the Patient Health Ques-
tionnaire-9 (PHQ-9), support adherence to medications, and provide brief
evidence-based forms of psychotherapy, such as problem-solving, cognitive
behavioral, or interpersonal therapy (Gilbody et al., 2006). Collaborative
care teams also usually include a consulting psychiatrist who provides
caseload-focused supervision for a panel of patients treated in primary
care. The psychiatrist advises primary care providers about diagnostic and
therapeutic approaches if patients are not improving with initial treatments,
and they may provide in-person consultation for selected patients with per-
sistent symptoms or diagnostic complexity. Collaborative care models have
been tested in over 40 primary care–based randomized controlled trials and
have been shown to be more effective than usual primary care in improving
quality of depression care and depression and functional outcomes for up
to 2 years (Gilbody et al., 2006).
In recent years collaborative care approaches have also been tested in
patients with depression and chronic medical illness. Three collaborative
care trials have been completed in primary care patients with comorbid
depression and diabetes (Ell et al., 2010; Katon et al., 2004b; Williams et
al., 2004). In each of these trials, intervention patients were provided with
a psychiatrically supervised case manager who offered an initial choice of
problem-solving treatment (PST) or antidepressant medication (Ell et al.,
2010; Katon et al., 2004b; Williams et al., 2004). Patients were treated with
stepped care principles so if they did not respond to therapy, a medication
could be added, or if they did not respond to an initial medication, another
medication could be tried or PST could be added. Collaborative care was
shown to improve quality of depression care, depression outcomes, func-
tioning, and patient satisfaction with care compared with usual care (Ell et
al., 2010; Katon et al., 2004b; Williams et al., 2004). Moreover, collabora-
tive care compared with usual care was shown to be associated with savings
in total medical costs in each of these three randomized controlled trials
(Hays et al., 2011; Katon et al., 2006; Simon et al., 2007).
The IMPACT trial randomized 1,801 aging patients with major de-
pression and/or dysthymia from 8 health care organizations to collab-
orative care and usual care. These patients had a mean of four chronic
medical illnesses. Compared with usual primary care, collaborative care
was associated with improved quality of depressive care and functional
and depression outcomes over a 2-year period (Katon et al., 2005a). In
IMPACT, the cost of collaborative care was offset by savings in medical
costs over a 2-year period (Katon et al., 2005a). In one of the above dia-
betes depression collaborative care trials and in the IMPACT trial, long-
term costs were examined and showed continued cost savings for up to
OCR for page 271
271
APPENDIX A
5 years compared with usual primary care (Katon et al., 2008a; Unützer
et al., 2008).
Two trials of collaborative care have also been shown to improve
quality of care and outcomes in cardiac patients compared with usual care.
Rollman and colleagues tested a telephone-based depression collaborative
care model delivered by nurses working with patients’ primary care provid-
ers to enhance antidepressant medication treatment, patient education, and
behavioral activation (Rollman et al., 2009). In 302 postcoronary bypass
graft patients with comorbid depression, this intervention was associated
with significant improvements in depression symptoms and mental health
functioning over an 8-month period compared with usual care (Rollman et
al., 2009). Davidson and colleagues tested a depression collaborative care
model that gave patients a choice of starting treatment with pharmaco-
therapy or problem-solving treatment in 157 patients persistently depressed
for 3 months after an acute coronary event (Davidson et al., 2010). Collab-
orative care compared with usual primary care was shown to significantly
improve depressive symptoms over a 1-year period (Davidson et al., 2010).
Four collaborative care trials have also been tested in patients with co-
morbid depression and cancer (Ell et al., 2008; Fann et al., 2009; Kroenke
et al., 2010; Strong et al., 2008). Fann and colleagues examined results
from the 215 patients with depression and cancer enrolled in the IMPACT
trial (Fann et al., 2009). Patients randomized to collaborative care had
significant improvements in depressive symptoms and functioning and en-
hanced quality of life compared with those randomized to usual care (Fann
et al., 2009). Strong and colleagues randomized 200 patients with comor-
bid depression and cancer to collaborative care and usual care (Strong et
al., 2008). Collaborative care involved a nurse-delivered intervention that
included a choice of either problem-solving treatment or antidepressant
medication provided by the patient’s primary care physician. Patients in
the intervention group have improved depression, anxiety, and fatigue
outcomes compared with usual care over a 12-month period (Strong et al.,
2008).
Kroenke and colleagues tested a collaborative care approach for 405
patients with cancer with either comorbid depression, significant persistent
pain, or both (Kroenke et al., 2010). The intervention was a telephone-
based care management program that provided education about pain and
depression, and a stepped medication algorithm for both pain and depres-
sion based on patient symptoms measured on standard scales (Kroenke et
al., 2010). Nurses were supervised weekly by both pain and psychiatric
specialists and medication recommendations were communicated by nurse
managers to patients’ primary care physicians. Intervention patients had
significant decreases in both pain and depressive symptoms compared with
usual care controls over a 12-month period.
OCR for page 274
274 LIVING WELL WITH CHRONIC ILLNESS
flaws; when analyses were restricted to more robust trials, there was a
moderate but nonsignificant beneficial effect of exercise compared with
nonexercise control groups (Mead et al., 2008). A critique of these studies
is that, although many of the enrolled patients had mild depression based
on a depression rating scale score, most would not meet criteria for major
depression or dysthymia. A more recent systematic review included only
studies in which a clinical diagnosis of depression was made. That review
found a short-term mild significant effect of exercise on depression com-
pared with nonexercise control groups (Krogh et al., 2011). However, there
was limited evidence of a beneficial long-term effect, with the trials lasting
more than 10 weeks no longer showing significant effects.
A key critique of exercise trials has been the potential lack of generaliz-
ability to populations of depressed patients. Symptoms of depression, such
as lack of motivation and energy, will probably limit the ability of many
patients to enroll in these studies. Thus, even if exercise has a modest effect
in ameliorating symptoms of depression, it is likely to have only mild effects
on decreasing prevalence of serious depression in populations.
Several small trials have suggested that yoga and meditation may have
beneficial effects on depression. These trials need replication in larger num-
bers of patients meeting criteria for major depression or dysthymia.
HEALTH POLICY CHANGES THAT COULD IMPROVE
QUALITY AND OUTCOMES OF DEPRESSION CARE
Berwick has emphasized that major organizational changes will be nec-
essary for medical care systems to adapt existing primary care and medical
specialty services to optimize care of patients with chronic illnesses, such
as depression or diabetes (Berwick et al., 2003). These changes include
investing in clinical information systems, such as registries to help track
the quality and outcomes of care in specific populations; linking these sys-
tems to medical records; and designing decision support systems that will
develop and implement treatment guidelines in a timely manner (Berwick
et al., 2003). Organizational changes will also be needed to create delivery
systems, such as depression management teams to implement more frequent
systematic follow-up and monitoring of outcomes, promote integration of
mental health specialty care into primary care, and develop self-manage-
ment tool-kits for patients and providers.
Economic incentives and regulatory changes will be needed to imple-
ment these costly changes in care. As Berwick has emphasized, “For most
organizations, investment on this scale is a strategic issue and will only be
undertaken if the market—employers and government purchasers, princi-
pally and consumers secondarily—permits and rewards these strategies”
(Berwick et al., 2003).
OCR for page 275
275
APPENDIX A
Key “demand side” levers include increasing community, consumer,
and employer demand for integrating evidence-based changes in systems
of care, aligning financial models of care to defray the costs of reorganiz-
ing health services to provide “collaborative care, and developing new
Health Plan Employer Data Information Set (HEDIS) depression perfor-
mance criteria that evidence suggests are linked with improved outcomes”
(Katon and Seelig, 2008b). Increasing demand will necessitate education of
consumer groups, employers, and insurers about cost-effective models to
improve depression care, including information on how these models may
decrease overall medical costs in patients with comorbid medical illnesses,
such as diabetes (Katon and Seelig, 2008b). Katon and Selig have reported
that “several of the research groups involved in dissemination of collabora-
tive care are working with consumer groups, such as the American Associa-
tion of Retired Persons (AARP), and the Depression and Bipolar Support
Alliance, to lobby insurers to develop payment systems for collaborative
care” (Katon and Seelig, 2008b). An innovative approach would be to have
insurers help pay for the cost of training and changes in systems of care
to help defray initial investment costs, since health insurers are likely to
realize cost savings with collaborative care programs. Employers have also
recognized the adverse impact of poor quality of care of chronic illnesses
like depression on the workforce in terms of decreased productivity, absen-
teeism, and disability (Stewart et al., 2003). Recent research suggests that
employed patients with depression who have poor adherence to acute and
continuation phase antidepressant treatment were 39 and 46 percent more
likely, respectively, to file short-term disability claims (Burton et al., 2007).
Wang and colleagues have shown that an innovative program combining
depression screening with telephone-based collaborative depression care
improved both depression outcomes and work productivity compared with
usual care when implemented in a large corporation (Wang et al., 2007).
Based on research demonstrating the effectiveness of collaborative care, the
National Business Group on Health has recently strongly recommended
implementation of payment for evidence-based collaborative care programs
for depression (Finch and Phillips, 2005).
In primary care systems, quality improvement efforts to integrate de-
pression collaborative care programs have been hindered by lack of billing
codes for the depression care manager in-person and telephone visits and
time for caseload supervision by a psychiatrist. Development of Medicare
billing codes for these crucial components of collaborative care could en-
hance dissemination efforts of this evidence-based model. The six major
insurers in Minnesota are collaborating in a quality improvement project
(DIAMOND program) for depression in primary care and have developed
payment models for the above components of collaborative care; early re-
OCR for page 276
276 LIVING WELL WITH CHRONIC ILLNESS
ports suggest high levels of patient recovery similar to randomized trials of
collaborative care (Korsen and Pietruszewski, 2009).
Changes in health insurance that provide higher payments for enhanced
outcomes of populations with chronic illnesses such as depression could
also enhance dissemination of collaborative care. Most collaborative care
trials have enhanced clinical response to depression treatment (percentage
of patients with at least 50 percent decrease in depressive symptoms) by 15
to 30 percent (Gilbody et al., 2006). However, lack of financial incentives
for clinical improvement as well as difficulty billing for the mental health
services utilized in collaborative care has made investment in integrating
depression care managers and supervising psychiatrists difficult for systems
of care.
Another key policy change that could enhance dissemination of col-
laborative care is to develop HEDIS performance criteria that research
suggests are “tightly linked” to enhanced outcomes (Kerr et al., 2001).
The current criteria include documenting the percentage of patients receiv-
ing at least 3 visits in the 90 to 120 days after diagnosis and initiation of
treatment in primary care as well as the percentage of patients adhering to
antidepressant medications at 3 and 6 months (Druss, 2004; NCQA, 2000).
These criteria have not been shown by researchers to be linked to enhanced
outcomes. Moreover only 20 percent of patients across multiple systems of
care actually receive the three visits that HEDIS criteria suggest are impor-
tant (Druss, 2004). Many patients who are taking their antidepressant at
6 months are still on the small dosage that was started, which makes few
patients better. Most patients need upward titration of medication based
on measurement of depressive symptom response, and they often need a
second or third medication trial before an optimum type and dosage of
antidepressant is found. A performance criterion tightly linked to outcomes
could be the percentage of patients with less than a 50 percent decrease
in symptoms 12 weeks after initiating antidepressant treatment who re-
ceive intensification of depression treatment, such as increased dosage of
medication, change to a second medication, or referral for a mental health
consultation. Payments to health organizations that report improvement
in percentage of patients with at least a 50 percent improvement in their
initial level of depressive symptoms at 3 and 6 months could also increase
motivation for systems of care to integrate evidence-based models of care.
PREVENTION OF DEPRESSION IN PATIENTS
WITH CHRONIC MEDICAL ILLNESSES
Preventive interventions to decrease incidence of depression in patients
with chronic medical illness have been developed in recent years. Rovner
and colleagues tested the effect of problem-solving therapy (PST) in patients
OCR for page 277
277
APPENDIX A
with macular degeneration in one eye and a recent change in vision due to
macular disease in the other eye (Rovner et al., 2007). The rationale for
this study was data suggesting high rates of depression in patients who
developed this irreversible disease. Patients randomized to PST and usual
care were found to have significantly lower incidence of depression and
were less likely to have decreased function (Rovner et al., 2007). de Jonge
and colleagues tested a multifaceted nurse intervention aimed at prevent-
ing depression in 100 patients with diabetes or rheumatological disease
(de Jonge et al., 2009). At 1-year follow-up, lower rates of incident depres-
sion were found in intervention versus usual care patients (36 versus 63
percent) (de Jonge et al., 2009). Pitceathly and colleagues tested a brief
psychological intervention versus usual care in a large sample of patients
recently diagnosed with cancer (Pitceathly et al., 2009). Although at 12
months there were no intervention versus control differences in incident
depression in the overall group (intent-to-treat analysis), among patients
with a high risk of depression, a significant intervention effect was found
(Pitceathly et al., 2009). Robinson and colleagues tested antidepressants
versus PST versus placebo to prevent depression in 176 patients with a
recent stroke (Robinson et al., 2008). Over the 12-month period, patients
receiving placebo were more likely to develop depression compared with
those receiving antidepressants or PST (Robinson et al., 2008).
The above studies are promising, but more studies are needed. A key
question will be to determine whether it is cost-effective to provide preven-
tive interventions to only high-risk groups, such as those with a prior his-
tory of anxiety and/or depression. Our research group has found in a 5-year
longitudinal study of approximately 3,000 patients with type 2 diabetes
that over 80 percent who were depressed at 5-year follow-up either had
minor or major depression at baseline (Katon et al., 2009). These data and
the results of the above studies suggest preventive treatment of high-risk
populations may be most cost-effective.
COMMUNITY APPROACHES TO IMPROVING
TREATMENT OF DEPRESSION
One exciting community-based effort that could be implemented to
disseminate collaborative care would be for the Center for Medicare and
Medicaid Innovations to develop a dissemination project to test the cost-
effectiveness of collaborative care in a large region of the United States.
Given the evidence that depression increases medical costs by 50 to 100
percent and that collaborative care often is associated with total medical
cost savings, this would seem like a logical next step to decrease Medicare
and Medicaid costs. This project could build on the effective training model
used in the DIAMOND project that has improved quality and outcomes
OCR for page 278
278 LIVING WELL WITH CHRONIC ILLNESS
of depression care among primary care patients in Minnesota (Korsen and
Pietruszewski, 2009).
A second exciting community-based project would involve testing
methods to improve mental health care for patients in federally qualified
primary care clinics and the medical care of patients with chronic mental
illness enrolled in community mental health systems. Funding from the
Substance Abuse and Mental Health Services Administration has helped
stimulate new models of care with funding for demonstration projects for
these two systems to enhance coordination of mental health and physical
health care. This funding has led to unique partnerships in which primary
care physicians and advanced registered nurse practitioners from federally
funded primary care clinics have established clinics in community mental
health centers, and, in turn, mental health practitioners from community
mental health centers have established clinics in federally funded primary
care clinics.
CONCLUSION
In summary, depression and chronic medical illnesses are associated
with functional decline in aging populations. Depression is two to three
times more common in people with chronic conditions (Katon, 2011),
but there are major gaps in recognition and quality of care for this affec-
tive illness. Interventions have been developed and integrated into both
community-based public health platforms and primary care platforms and
have been shown in randomized controlled trials to improve depression and
functional outcomes. Several of the primary care–based collaborative care
intervention programs have also shown a high likelihood of total medical
cost savings over a 2-year period. Key changes in reimbursement for these
new models of care will need to be completed to enhance dissemination
effects.
REFERENCES
Ali, S., M.A. Stone, J.L. Peters, M.J. Davies, and K. Khunti. 2006. The prevalence of co-
morbid depression in adults with Type 2 diabetes: A systematic review and meta-analysis.
Diabetic Medicine 23(11):1165–1173.
AoA (Administration on Aging). 2001. Older Adults and Mental Health: Issues and Oppor-
tunities. Washington, DC: Department of Health and Human Services.
Asarnow, J.R., L.H. Jaycox, N. Duan, A.P. LaBorde, M.M. Rea, P. Murray, M. Anderson, C.
Landon, L. Tang, and K.B. Wells. 2005. Effectiveness of a quality improvement inter-
vention for adolescent depression in primary care clinics: A randomized controlled trial.
Journal of American Medical Association 293(3):311–319.
Banerjee, S., K. Shamash, A.J. Macdonald, and A.H. Mann. 1996. Randomised controlled trial
of effect of intervention by psychogeriatric team on depression in frail elderly people at
home. British Medical Journal 313(7064):1058–1061.
OCR for page 279
279
APPENDIX A
Bartels, S. J. 2003. Improving system of care for older adults with mental illness in the United
States. Findings and recommendations for the President’s New Freedom Commission on
Mental Health. American Journal of Geriatric Psychiatry 11(5):486–497.
Berwick, D.M., B. James, and M.J. Coye. 2003. Connections between quality measurement
and improvement. Medical Care 41(1 Supplemental):I30–I38.
Bifulco, A., P.M. Moran, C. Ball, and A. Lillie. 2002. Adult attachment style. II: Its relation-
ship to psychosocial depressive-vulnerability. Social Psychiatry and Psychiatric Epidemi-
ology 37(2):60–67.
Blanchard, E.B., L. Keefer, A. Payne, S.M. Turner, and T.E. Galovski. 2002. Early abuse,
psychiatric diagnoses and irritable bowel syndrome. Behaviour Research Therapy 40(3):
289–298.
Boult, C., L. Reider, B. Leff, K.D. Frick, C.M. Boyd, J.L. Wolff, K. Frey, L. Karm, S.T. Wegener,
T. Mroz, and D.O. Scharfstein. 2011. The effect of guided care teams on the use of
health services: Results from a cluster-randomized controlled trial. Archives of Internal
Medicine 171(5):460–466.
Burton, W.N., C.Y. Chen, D.J. Conti, A.B. Schultz, and D.W. Edington. 2007. The association
of antidepressant medication adherence with employee disability absences. American
Journal of Managed Care 13(2):105–112.
Caspi, A., K. Sugden, T.E. Moffitt, A. Taylor, I.W. Craig, H. Harrington, J. McClay, J. Mill,
J. Martin, A. Braithwaite, and R. Poulton. 2003. Influence of life stress on depression:
Moderation by a polymorphism in the 5-HTT gene. Science 301(5631):386–389.
Chung, B., L. Jones, E.L. Dixon, J. Miranda, K. Wells; Community Partners in Care Steering
Council. 2010. Using a community partnered participatory research approach to imple-
ment a randomized controlled trial: Planning community partners in care. Journal of
Health Care for the Poor and Underserved 21(3):780–795.
Ciechanowski, P., E. Wagner, K. Schmaling, S. Schwartz, B. Williams, P. Diehr, J. Kulzer, S.
Gray, C. Collier, and J. LoGerfo. 2004. Community-integrated home-based depression
treatment in older adults: A randomized controlled trial. Journal of American Medical
Association 291(13):1569–1577.
Ciechanowski, P., N. Chaytor, J. Miller, R. Fraser, J. Russo, J. Unützer, and F. Gilliam. 2010.
PEARLS depression treatment for individuals with epilepsy: A randomized controlled
trial. Epilepsy & Behavior 19(3):225–231.
Counsell, S.R., C.M. Callahan, D.O. Clark, W. Tu, A.B. Buttar, T.E. Stump, and G.D. Ricketts.
2007. Geriatric care management for low-income seniors: A randomized controlled trial.
Journal of American Medical Association 298(22):2623–2633.
Davidson, K.W., N. Rieckmann, L. Clemow, J.E. Schwartz, D. Shimbo, V. Medina, G.
Albanese, I. Kronish, M. Hegel, and M.M. Burg. 2010. Enhanced depression care for
patients with acute coronary syndrome and persistent depressive symptoms: Coronary
psychosocial evaluation studies randomized controlled trial. Archives of Internal Medi-
cine 170(7):600–608.
Davydow, D.S., J.E. Russo, E. Ludman, P. Ciechanowski, E.H. Lin, M. Von Korff, M. Oliver,
and W.J. Katon. 2011. The association of comorbid depression with intensive care
unit admission in patients with diabetes: A prospective cohort study. Psychosomatics
52(2):117–126.
de Jonge, P., F.B. Hadj, D. Boffa, C. Zdrojewski, Y. Dorogi, A. So, J. Ruiz, and F. Stiefel. 2009.
Prevention of major depression in complex medically ill patients: Preliminary results from
a randomized, controlled trial. Psychosomatics 50(3):227–233.
DiMatteo, M.R., H.S. Lepper, and T.W. Croghan. 2000. Depression is a risk factor for non-
compliance with medical treatment: Meta-analysis of the effects of anxiety and depres-
sion on patient adherence. Archives of Internal Medicine 160(14):2101–2107.
OCR for page 280
280 LIVING WELL WITH CHRONIC ILLNESS
Druss, B.G. 2004. A review of HEDIS measures and performance for mental disorders. Man-
aged Care 13(6 Supplemental Depression):48–51.
Egede, L.E., P.J. Nietert, and D. Zheng. 2005. Depression and all-cause and coronary heart dis-
ease mortality among adults with and without diabetes. Diabetes Care 28(6):1339–1345.
Ell, K., B. Xie, B. Quon, D.I. Quinn, M. Dwight-Johnson and P.J. Lee. 2008. Randomized
controlled trial of collaborative care management of depression among low-income pa-
tients with cancer. Journal of Clinical Oncology 26(27):4488–4496.
Ell, K., W. Katon, B. Xie, P.J. Lee, S. Kapetanovic, J. Guterman, and C.P. Chou. 2010.
Collaborative care management of major depression among low-income, predomi-
nantly Hispanic subjects with diabetes: A randomized controlled trial. Diabetes Care
33(4):706–713.
Fann, J.R., M.Y. Fan, and J. Unützer. 2009. Improving primary care for older adults with
cancer and depression. Journal of General Internal Medicine 24(Suppl 2):S417–S424.
Finch, R.A., and K. Phillips. 2005. An employer’s guide to behavioral health services: A
roadmap and recommendations for evaluating, designing, and implementing behavioral
health services. Center for Prevention and Health Services, National Business Group on
Health. Washington, DC.
Florio, E.R., and R. Raschko. 1998. The gatekeeper model: Implications for social policy.
Journal of Aging and Social Policy 10(1):37–55.
Florio, E.R., J.E. Jensen, M. Hendryx, R. Raschko, and K. Mathieson. 1998. One-year
outcomes of older adults referred for aging and mental health services by community
gatekeepers. Journal of Case Management 7(2):74–83.
Fries, J.F. 1980. Aging, natural death, and the compression of morbidity. New England Journal
of Medicine 303(3):130–135.
Gilbody, S., P. Bower, J. Fletcher, D. Richards, and A.J. Sutton. 2006. Collaborative care for
depression: a cumulative meta-analysis and review of longer-term outcomes. Archives of
Internal Medicine 166(21):2314–2321.
Gill, D., and S. Hatcher. 2000. Antidepressants for depression in medical illness. Cochrane
Database Systematic Reviews (4):CD001312.
Guralnik, J.M., and G.A. Kaplan. 1989. Predictors of healthy aging: Prospective evidence from
the Alameda County study. American Journal of Public Health 79(6):703–708.
Hays, J., W. Katon, K. Ell, P.J. Lee, and J.J. Guterman. 2011. Cost effectiveness analysis of
collaborative care management for major depression among low-income, predominately
Hispanics with diabetes: assessment in psychiatry. Tenth Workshop on Costs and As-
sessment in Psychiatry. Venice, Italy: Mental Health Policy and Economics. March 14.
HHS (U.S. Department of Health and Human Services). 1999. Mental Health: A Report of
the Surgeon General. Washington, DC: Office of the Surgeon General, U.S. Public Health
Service, U.S. Department of Health and Human Services.
Hoffman, C., D. Rice, and H.Y. Sung. 1996. Persons with chronic conditions. Their prevalence
and costs. Journal of American Medical Association 276(18):1473–1479.
Katon, W.J. 2003. Clincial health services and relationship between major depression, depres-
sive symptoms, and general medical illness. Biological Pyschiatry 54:216–226.
Katon, W.J. 2011. Epidemiology and treatment of depression in patients with chronic medical
illness. Dialogues in Clinical Neuroscience 13(1):7–23.
Katon, W., and H. Schulberg. 1992. Epidemiology of depression in primary care. General
Hospital Psychiatry 14(4):237–247.
Katon, W.J., G. Simon, J. Russo, M. Von Korff, E.H. Lin, E. Ludman, P. Ciechanowski, and
T. Bush. 2004a. Quality of depression care in a population-based sample of patients with
diabetes and major depression. Medical Care 42(12):1222–1229.
OCR for page 281
281
APPENDIX A
Katon, W.J., M. Von Korff, E.H. Lin, G. Simon, E. Ludman, J. Russo, P. Ciechanowski,
E. Walker, and T. Bush. 2004b. The Pathways Study: A randomized trial of collab-
orative care in patients with diabetes and depression. Archives of General Psychiatry
61(10):1042–1049.
Katon, W.J., M. Schoenbaum, M.Y. Fan, C.M. Callahan, J. Jr. Williams, E. Hunkeler, L.
Harpole, X.H. Zhou, C. Langston, and J. Unützer. 2005a. Cost-effectiveness of im-
proving primary care treatment of late-life depression. Archives of General Psychiatry
62(12):1313–1320.
Katon, W.J., C. Rutter, G. Simon, E.H. Lin, E. Ludman, P. Ciechanowski, L. Kinder, B. Young,
and M. Von Korff. 2005b. The association of comorbid depression with mortality in
patients with type 2 diabetes. Diabetes Care 28(11):2668–2672.
Katon, W., J. Unützer, M.Y. Fan, J.W. Jr. Williams, M. Schoenbaum, E.H. Lin, and E.M.
Hunkeler. 2006. Cost-effectiveness and net benefit of enhanced treatment of depression
for older adults with diabetes and depression. Diabetes Care 29(2):265–270.
Katon, W., E.H. Lin, and K. Kroenke. 2007. The association of depression and anxiety with
medical symptom burden in patients with chronic medical illness. General Hospital
Psychiatry 29(2):147–155.
Katon, W.J., J.E. Russo, M. Von Korff, E.H. Lin, E. Ludman, and P.S. Ciechanowski. 2008a.
Long-term effects on medical costs of improving depression outcomes in patients with
depression and diabetes. Diabetes Care 31(6):1155–1159.
Katon, W.J., and M. Seelig 2008b. Population-based care of depression: Team care ap -
proaches to improving outcomes. Journal of Occupation and Environmental Medicine
50(4):459–467.
Katon, W., J. Russo, E.H. Lin, S.R. Heckbert, P. Ciechanowski, E.J. Ludman, and M. Von
Korff. 2009. Depression and diabetes: Factors associated with major depression at five-
year follow-up. Psychosomatics 50(6):570–579.
Katon, W.J., E.H. Lin, M. Von Korff, P. Ciechanowski, E.J. Ludman, B. Young, D. Peterson,
C.M. Rutter, M. McGregor, and D. McCulloch. 2010a. Collaborative care for pa-
tients with depression and chronic illnesses. New England Journal of Medicine 363(27):
2611–2620.
Katon, W.J., E.H. Lin L.H. Williams, P. Ciechanowski, S.R. Heckbert, E. Ludman, C. Rutter,
P.K. Crane, M. Oliver, and M. Von Korff. 2010b. Comorbid depression is associated with
an increased risk of dementia diagnosis in patients with diabetes: A prospective cohort
study. Journal of General Internal Medicine 25(5):423–429.
Katon, W., L. Richardson, J. Russo, C.A. McCarty, C. Rockhill, E. McCauley, J. Richards,
and D.C. Grossman. 2010c. Depressive symptoms in adolescence: The association with
multiple health risk behaviors. General Hospital Psychiatry 32(3):233–239.
Katon, W.J., J. Russo, and E. Lin. Unpublished. Cost-effectiveness of a multi-condition collab -
orative care intervention: A randomized controlled trial. Archives of General Psychiatry.
Kendler, K., C. Gardner, and C.A. Prescott. 2002. Toward a comprehensive developmental
model for major depression in women. American Journal of Psychiatry 159(7):1133–1145.
Kennedy, G.J., H.R. Kelman, and C. Thomas. 1991. Persistence and remission of depressive
symptoms in late life. American Journal of Psychiatry 148(2):174–178.
Kerr, E.A., S.L. Krein, S. Vijan, T.P. Hofer, and R.A. Hayward. 2001. Avoiding pitfalls in
chronic disease quality measurement: A case for the next generation of technical quality
measures. American Journal of Managed Care 7(11):1033–1043.
Korsen, N., and P. Pietruszewski. 2009. Translating evidence to practice: Two stories from the
field. Journal of Clinical Psychology in Medical Settings 16(1):47–57.
OCR for page 282
282 LIVING WELL WITH CHRONIC ILLNESS
Kroenke, K., M.J. Bair, T.M. Damush, J. Wu, S. Hoke, J. Sutherland, and W. Tu. 2009. Op-
timized antidepressant therapy and pain self-management in primary care patients with
depression and musculoskeletal pain: A randomized controlled trial. Journal of American
Medical Association 301(20):2099–2110.
Kroenke, K., D. Theobald, J. Wu, K. Norton, G. Morrison, J. Carpenter, and W. Tu. 2010.
Effect of telecare management on pain and depression in patients with cancer: A random-
ized trial. Journal of American Medical Association 304(2):163–171.
Krogh, J., M. Nordentoft, J.A. Sterne, and D.A. Lawlor. 2011. The effect of exercise in clini-
cally depressed adults: Systematic review and meta-analysis of randomized controlled
trials. Journal of Clinical Psychiatry 72(4):529–538.
Lesperance, F., N. Frasure-Smith, D. Koszycki, M.A. Laliberté, L.T. van Zyl, B. Baker, J.R.
Swenson, K. Ghatavi, B.L. Abramson, P. Dorian, and M.C. Guertin; CREATE Investi-
gators. 2007. Effects of citalopram and interpersonal psychotherapy on depression in
patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of
Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of American Medical
Association 297(4):367–379.
Lin, E.H., W. Katon, M. Von Korff, L. Tang, J.W. Jr. Williams, K. Kroenke, E. Hunkeler, L.
Harpole, M. Hegel, P. Arean, M. Hoffing, R. Della Penna, C. Langston, and J. Unützer;
IMPACT Investigators. 2003. Effect of improving depression care on pain and functional
outcomes among older adults with arthritis: A randomized controlled trial. Journal of
American Medical Association 290(18):2428–2429.
Lin, E.H., W. Katon, M. Von Korff, C. Rutter, G.E. Simon, M. Oliver, P. Ciechanowski, E.J.
Ludman, T. Bush, and B. Young. 2004. Relationship of depression and diabetes self-care,
medication adherence, and preventive care. Diabetes Care 27(9):2154–2160.
Lin, E.H., S.R. Heckbert, C.M. Rutter, W.J. Katon, P. Ciechanowski, E.J. Ludman, M. Oliver,
B.A. Young, D.K. McCulloch, and M. Von Korff. 2009. Depression and increased mor-
tality in diabetes: Unexpected causes of death. Annals of Family Medicine 7(5):414–421.
Lin, E.H., C.M. Rutter, W. Katon, S.R. Heckbert, P. Ciechanowski, M.M. Oliver, E.J. Lud-
man, B.A. Young, L.H. Williams, D.K. McCulloch, and M. Von Korff. 2010. Depres-
sion and advanced complications of diabetes: A prospective cohort study. Diabetes Care
33(2):264–269.
Llewellyn-Jones, R.H., K.A. Baikie, H. Smithers, J. Cohen, J. Snowdon, and C.C. Tennant.
1999. Multifaceted shared care intervention for late life depression in residential care:
Randomised controlled trial. British Medical Journal 319(7211):676–682.
Ludman, E. J., W. Katon, J. Russo, M. Von Korff, G. Simon, P. Ciechanowski, E. Lin, T. Bush,
E. Walker, and B. Young. 2004. Depression and diabetes symptom burden. General
Hospital Psychiatry 26(6):430–436.
McCall, N.T., P. Parks, K. Smith, G. Pope, and M. Griggs. 2002. The prevalence of major de-
pression or dysthymia among aged Medicare Fee-for-Service beneficiaries. International
Journal of Geriatric Psychiatry 17(6):557–565.
Mead, G.E., W. Morley, P. Campbell, C.A. Greig, M. McMurdo, and D.A. Lawlor. 2008.
Exercise for depression. Cochrane Database Systematic Reviews (4):CD004366.
Mor, V. 2005. The compression of morbidity hypothesis: A review of research and prospects
for the future. Journal of the American Geriatrics Society 53(9 Suppl):S308–S309.
NCQA (National Center for Quality Assurance). 2000. The State of Managed Care Quality
2000. Washington, DC: National Center for Quality Assurance.
Partnership for Solutions National Program Office. 2001. Chronic Conditions: Making the
Case for Ongoing Care. Robert Wood Johnson Foundation.
Pitceathly, C., P. Maguire, I, Fletcher, M. Parle, B. Tomenson, and F. Creed. 2009. Can a brief
psychological intervention prevent anxiety or depressive disorders in cancer patients? A
randomised controlled trial. Annals of Oncology 20(5):928–934.
OCR for page 283
283
APPENDIX A
Pyne, J.M., J.C. Fortney, G.M. Curran, S. Tripathi, J.H. Atkinson, A.M. Kilbourne, H.J.
Hagedorn, D. Rimland, M.C. Rodriguez-Barradas, T. Monson, K.A. Bottonari, S.M.
Asch, and A.L. Gifford. 2011. Effectiveness of collaborative care for depression in human
immunodeficiency virus clinics. Archives of Internal Medicine 171(1):23–31.
Rabins, P.V., B.S. Black, R. Roca, P. German, M. McGuire, B. Robbins, R. Rye, and L. Brant.
2000. Effectiveness of a nurse-based outreach program for identifying and treating psychi -
atric illness in the elderly. Journal of American Medical Association 283(21):2802–2809.
Robinson, R.G., R.E. Jorge, D.J. Moser, L. Acion, A. Solodkin, S.L Small, P. Fonzetti, M.
Hegel, and S. Arndt. 2008. Escitalopram and problem-solving therapy for prevention
of poststroke depression: A randomized controlled trial. Journal of American Medical
Association 299(20):2391–2400.
Rollman, B.L., B.H. Belnap, M.S. LeMenager, S. Mazumdar, P.R. Houck, P.J. Counihan, W.N.
Kapoor, H.C. Schulberg, and C.F. Reynolds III. 2009. Telephone-delivered collabora-
tive care for treating post-CABG depression: A randomized controlled trial. Journal of
American Medical Association 302(19):2095–2103.
Rovner, B.W., R.J. Casten, M.T. Hegel, B.E. Leiby, and W.S. Tasman. 2007. Preventing depres-
sion in age-related macular degeneration. Archives of General Psychiatry 64(8):886–892.
Rowe, J.W., and R.L. Kahn 1987. Human aging: Usual and successful. Science 237(4811):
143–149.
Schafer, I., E.C. von Leitner, G. Schön, D. Koller, H. Hansen, T. Kolonko, H. Kaduszkiewicz,
K. Wegscheider, G. Glaeske, and H. van den Bussche. 2010. Multimorbidity patterns in
the elderly: a new approach of disease clustering identifies complex interrelations between
chronic conditions. PLoS One 5(12):e15941.
Schleifer, S.J., M.M. Macari-Hinson, D.A. Coyle, W.R Slater, M. Kahn, R. Gorlin, and H.D.
Zucker. 1989. The nature and course of depression following myocardial infarction.
Archives of Internal Medicine 149(8):1785–1789.
Simon, G.E., W.J. Katon, E.H. Lin, E. Ludman, M. VonKorff, P. Ciechanowski, and B.A.
Young. 2005. Diabetes complications and depression as predictors of health care costs.
General Hospital Psychiatry 27(5):344–351.
Simon, G.E., W.J. Katon, E.H. Lin, C. Rutter, W.G. Manning, M. Von Korff, P. Ciechanowski,
E.J. Ludman, and B.A. Young. 2007. Cost-effectiveness of systematic depression treat-
ment among people with diabetes mellitus. Archives of General Psychiatry 64(1):65–72.
Spijkerman, T., P. de Jonge, R.H. van den Brink, J.H. Jansen, J.F. May, H.J. Crijns, and J.
Ormel. 2005. Depression following myocardial infarction: First-ever versus ongoing and
recurrent episodes. General Hospital Psychiatry 27(6):411–417.
Stewart, W.F., J.A. Ricci, E. Chee, S.R. Hahn, and D. Morganstein. 2003. Cost of lost pro-
ductive work time among US workers with depression. Journal of American Medical
Association 289(23):3135–3144.
Strong, V., R. Waters, C. Hibberd, G. Murray, L. Wall, J. Walker, G. McHugh, A. Walker, and
M. Sharpe. 2008. Management of depression for people with cancer (SMaRT oncology
1): A randomised trial. Lancet 372(9632):40–48.
Sullivan, M., G. Simon, J. Spertus, and J. Russo. 2002. Depression-related costs in heart failure
care. Archives of Internal Medicine 162(16):1860–1866.
Unützer, J., G. Simon, T.R. Belin, M. Datt, W. Katon, and D. Patrick. 2000. Care for de-
pression in HMO patients aged 65 and older. Journal of American Geriatrics Society
48(8):871–878.
Unützer, J., W. Katon, C.M. Callahan, J.W. Jr. Williams, E. Hunkeler, L. Harpole, M. Hoffing,
R.D. Della Penna, P.H. Noël, E.H. Lin, P.A. Areán, M.T. Hegel, L. Tang, T.R. Belin, S.
Oishi, and C. Langston; IMPACT Investigators. Improving Mood-Promoting Access to
Collaborative Treatment. 2002. Collaborative care management of late-life depression
in the primary care setting: A randomized controlled trial. Journal of American Medical
Association 288(22):2836–2845.
OCR for page 284
284 LIVING WELL WITH CHRONIC ILLNESS
Unützer, J., W.J. Katon, M.Y. Fan, M.C. Schoenbaum, E.H. Lin, R.D. Della Penna, and D.
Powers. 2008. Long-term cost effects of collaborative care for late-life depression. Ameri-
can Journal of Managed Care 14(2):95–100.
Van Citters, A.D., and S.J. Bartels. 2004. A systematic review of the effectiveness of
community-based mental health outreach services for older adults. Psychiatric Services
55(11):1237–1249.
van der Feltz-Cornelis, C.M., J. Nuyen, C. Stoop, J. Chan, A.M. Jacobson, W. Katon, F.
Snoek, and N. Sartorius. 2010. Effect of interventions for major depressive disorder and
significant depressive symptoms in patients with diabetes mellitus: A systematic review
and meta-analysis. General Hospital Psychiatry 32(4):80–395.
van Melle, J.P., P. de Jonge, T.A. Spijkerman, J.G. Tijssen, J. Ormel, D.J. van Veldhuisen, R.H.
van den Brink, and M.P. van den Berg. 2004. Prognostic association of depression fol-
lowing myocardial infarction with mortality and cardiovascular events: A meta-analysis.
Psychosomatic Medicine 66(6):814–822.
Von Korff, M., W. Katon, E.H. Lin, G. Simon, E. Ludman, M. Oliver, P. Ciechanowski, C.
Rutter, and T. Bush. 2005. Potentially modifiable factors associated with disability among
people with diabetes. Psychosomatic Medicine 67(2):233–240.
Von Korff, M., W.J. Katon, E.H. Lin, P. Ciechanowski, D. Peterson, E.J. Ludman, B. Young,
and C.M. Rutter. 2011. Functional outcomes of multi-condition collaborative care and
successful aging. British Medical Journal 343:d6612.
Wang, P.S., G.E. Simon, J. Avorn, F. Azocar, E.J. Ludman, J. McCulloch, M.Z. Petukhova, and
R.C. Kessler. 2007. Telephone screening, outreach, and care management for depressed
workers and impact on clinical and work productivity outcomes: A randomized con-
trolled trial. Journal of American Medical Association 298(12):1401–1411.
Williams, J.W., Jr., W. Katon, E.H. Lin, P.H. Nöel, J. Worchel, J. Cornell, L. Harpole, B.A.
Fultz, E. Hunkeler, V.S. Mika, and J. Unützer; IMPACT Investigators. 2004. The effec-
tiveness of depression care management on diabetes-related outcomes in older patients.
Annals of Internal Medicine 140(12):1015–1024.
Williams, L.H., C.M. Rutter, W.J. Katon, G.E. Reiber, P. Ciechanowski, S.R. Heckbert, E.H.
Lin, E.J. Ludman, M.M. Oliver, B.A. Young, and M. Von Korff. 2010. Depression and
incident diabetic foot ulcers: A prospective cohort study. American Journal of Medicine
123(8):748–754.
Zhang, X., S.L. Norris, E.W. Gregg, Y.J. Cheng, G. Beckles, and H.S. Kahn. 2005. Depressive
symptoms and mortality among persons with and without diabetes. American Journal
of Epidemiology 161(7):652–660.
