TY - JOUR
KW - Adult
KW - Aged
KW - Cluster Analysis
KW - Depression/complications/diagnosis/therapy
KW - Depressive Disorder, Major/complications
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Care Team
KW - Primary Health Care/methods
KW - Quality of Life
KW - Surveys and Questionnaires
KW - Treatment Outcome
AU - J. J. Petersen
AU - J. Hartig
AU - M. A. Paulitsch
AU - M. Pagitz
AU - K. Mergenthal
AU - S. Rauck
AU - A. Reif
AU - F. M. Gerlach
AU - J. Gensichen
A1 - 
AB - PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
AD - Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.; Department of Educational Quality and Evaluation, German Institute for International Educational Research, Frankfurt am Main, Germany.; Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.; Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.; Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.; Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany.; Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.; Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.; Institute of General Practice and Family Medicine, Ludwig-Maximilians University Clinic, Munich, Germany.
BT - PloS one
C5 - General Literature
CP - 9
CY - United States
DO - 10.1371/journal.pone.0202245
IS - 9
JF - PloS one
M1 - Journal Article
N2 - PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
PP - United States
PY - 2018
SN - 1932-6203; 1932-6203
T1 - Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
T2 - PloS one
TI - Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
U1 - General Literature
U2 - 30192786
U3 - 10.1371/journal.pone.0202245
VL - 13
VO - 1932-6203; 1932-6203
Y1 - 2018
Y2 - Sep 7
ER -