Areán Patricia A, Gum Amber M, Tang Lingqi, Unützer Jürgen
Department of Psychiatry, University of California-San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
Psychiatr Serv. 2007 Aug;58(8):1057-64. doi: 10.1176/ps.2007.58.8.1057.
Older adults with low incomes rarely use mental health care, and untreated depression is a serious problem in this population. This study examined whether a collaborative care model for depression in primary care would increase use of depression treatment and treatment outcomes for low-income elderly adults as well as for higher-income older adults.
A multisite randomized clinical trial that included 1,801 adults aged 60 years and older who were diagnosed as having depression compared collaborative care for depression with treatment as usual in primary care. Participants were divided into groups by income definitions on the basis of criteria used by the U.S. Census Bureau and the U.S. Department of Housing and Urban Development (HUD). A total of 315 participants (18%) were living below the poverty level by the U.S. Census criteria, 261 (15%) were living below 30% of the area median income (AMI) (HUD criteria) but above poverty, 438 (24%) were living between 30% and 50% of the AMI, 327 (18%) were living between 50% and 80% of the AMI, and 460 (26%) were not poor. The income groups were compared on service use, satisfaction, depression severity, and physical health at baseline and at three, six, and 12 months after being randomly assigned to collaborative care or usual care.
The benefits for low-income older adults were similar to those for middle- and higher-income older adults. At 12 months, intervention patients in all economic brackets had significantly greater rates of depression care for both antidepressant medication and psychotherapy, greater satisfaction, lower depression severity, and less health-related functional impairment than usual care participants.
Lower-income older adults can experience benefits from collaborative management of depression in primary care similar to those of higher-income older adults, although they may require up to a year to reap physical health benefits.
低收入老年人很少使用心理健康护理服务，而未经治疗的抑郁症在这一人群中是一个严重问题。本研究探讨了初级保健中抑郁症的协作护理模式是否会增加低收入老年人以及高收入老年人对抑郁症治疗的使用和治疗效果。
一项多中心随机临床试验，纳入了1801名60岁及以上被诊断患有抑郁症的成年人，将抑郁症的协作护理与初级保健中的常规治疗进行比较。根据美国人口普查局和美国住房与城市发展部（HUD）使用的标准，参与者按收入定义分组。根据美国人口普查标准，共有315名参与者（18%）生活在贫困线以下，261名（15%）生活在地区收入中位数（AMI）的30%以下（HUD标准）但高于贫困线，438名（24%）生活在AMI的30%至50%之间，327名（18%）生活在AMI的50%至80%之间，460名（26%）不属于贫困人口。在随机分配到协作护理或常规护理后，对各收入组在基线以及3个月、6个月和12个月时的服务使用情况、满意度、抑郁严重程度和身体健康状况进行比较。
低收入老年人获得的益处与中高收入老年人相似。在12个月时，所有经济阶层的干预组患者在抗抑郁药物治疗和心理治疗方面接受抑郁症护理的比例均显著高于常规护理参与者，满意度更高，抑郁严重程度更低，与健康相关的功能损害也更少。
低收入老年人在初级保健中接受抑郁症协作管理可获得与高收入老年人类似的益处，尽管他们可能需要长达一年的时间才能获得身体健康方面的益处。
