University of Washington School of Social Work, Seattle, USA.
Int J Geriatr Psychiatry. 2011 Jul;26(7):758-64. doi: 10.1002/gps.2606. Epub 2010 Dec 9.
Depressed patients with comorbid post-traumatic stress disorder (PTSD) are more functionally impaired and may take longer to respond to depression treatment than patients without PTSD. This study examined the long-term effects of PTSD on depression severity, treatment response, and health care costs among older adults.
Patients were recruited from 18 primary care clinics in five states. A total of 1801 patients aged 60 years or older with major depression or dysthymia were randomized to Improving Mood Promoting Access to Collaborative Treatment (IMPACT) collaborative care or usual care. The study included 191 (10.6%) subjects who screened positive for PTSD. Depression severity, assessed by the Hopkins Depression Symptom Checklist, was used to estimate depression-free days (DFDs) over 24 months. Total health care costs included inpatient, outpatient, and pharmacy costs.
Depressed patients with PTSD had higher depression severity than patients without PTSD symptoms at baseline. Over 2 years, intervention patients with PTSD symptoms had relatively the same benefits from collaborative care (99 more DFDs than usual care patients) as patients without PTSD (108 more DFDs than usual care) (p = 0.85). Total health care costs did not differ significantly for depressed patients with and without PTSD symptoms.
Depressed older adults with PTSD symptoms were more depressed at baseline, but collaborative care (compared to usual care) produced similar improvements in depression severity in both groups. This reduction of depression symptoms was observed for up to 12 months after the intervention ended, suggesting that long-term improvements in depression are possible with collaborative care in patients with and without PTSD symptoms.
患有共病创伤后应激障碍（PTSD）的抑郁患者功能受损更严重，且对抑郁治疗的反应可能比没有 PTSD 的患者更慢。本研究考察了 PTSD 对老年人中抑郁严重程度、治疗反应和医疗保健费用的长期影响。
研究对象从五个州的 18 个初级保健诊所招募。共有 1801 名年龄在 60 岁及以上、患有重度抑郁症或恶劣心境的患者被随机分配至促进合作治疗获取的改善心境（IMPACT）联合护理或常规护理。研究纳入了 191 名（10.6%）筛查出 PTSD 的患者。采用 Hopkins 抑郁症状清单评估抑郁严重程度，估计 24 个月内无抑郁天数（DFD）。总医疗保健费用包括住院、门诊和药房费用。
基线时，患有 PTSD 的抑郁患者比没有 PTSD 症状的患者抑郁严重程度更高。在 2 年期间，有 PTSD 症状的干预组患者从联合护理中获得的益处与没有 PTSD 的患者相当（与常规护理相比，多 99 个 DFD）（p = 0.85）。有和没有 PTSD 症状的抑郁患者的总医疗保健费用没有显著差异。
基线时有 PTSD 症状的老年抑郁患者抑郁程度更严重，但与常规护理相比，联合护理（与常规护理相比）在两组患者中都能显著改善抑郁严重程度。这种抑郁症状的减少在干预结束后长达 12 个月内都有观察到，表明联合护理可使有和没有 PTSD 症状的患者的抑郁症状得到长期改善。
