TY - JOUR
KW - Adult
KW - Depression/complications/psychology/therapy
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Obesity/complications/psychology/therapy
KW - Patient Participation
KW - Surveys and Questionnaires
KW - Treatment Outcome
AU - N. Lv
AU - L. Xiao
AU - M. Majd
AU - P. W. Lavori
AU - J. M. Smyth
AU - L. G. Rosas
AU - E. M. Venditti
AU - M. B. Snowden
AU - M. A. Lewis
AU - E. Ward
AU - L. Lesser
AU - L. M. Williams
AU - K. M. J. Azar
AU - J. Ma
A1 - 
AB - INTRODUCTION: The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress. METHODS: Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results. RESULTS: Among 204 intervention participants (50.9 [SD, 12.2] years, 71% female, 72% non-Hispanic White, BMI 36.7 [6.9], PHQ-9 14.1 [3.2]), 31% (n = 63) had poor engagement, on average completing self-monitored weight in <3 of 46 weeks and <5 of 15 sessions. Among them, 50 (79%) discontinued the intervention by session 6 (week 8). Engaged participants (n = 141; 69%) self-monitored weight for 11-22 weeks, attended almost all 15 sessions, but showed variable treatment progress based on patterns of change in self-monitored weight and PHQ-9 scores over 12 months. Three patterns of weight change (%) represented minimal weight loss (n = 50, linear β1 = -0.06, quadratic β2 = 0.001), moderate weight loss (n = 61, β1 = -0.28, β2 = 0.002), and substantial weight loss (n = 12, β1 = -0.53, β2 = 0.005). Three patterns of change in PHQ-9 scores represented moderate depression without treatment progress (n = 40, intercept β0 = 11.05, β1 = -0.11, β2 = 0.002), moderate depression with treatment progress (n = 20, β0 = 12.90, β1 = -0.42, β2 = 0.006), and milder depression with treatment progress (n = 81, β0 = 7.41, β1 = -0.23, β2 = 0.003). The patterns diverged within 6-8 weeks and persisted throughout the intervention. Objectively measured weight loss and depression outcomes were significantly worse among participants with poor engagement or poor progress on either weight or PHQ-9 than those showing progress on both. CONCLUSIONS: Participants demonstrating poor engagement or poor progress could be identified early during the intervention and were more likely to fail treatment at the end of the intervention. This insight could inform individualized and timely optimization to enhance treatment efficacy. TRIAL REGISTRATION: ClinicalTrials.gov# NCT02246413.
AD - Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America.; Department of Medicine, Stanford University, Palo Alto, California, United States of America.; Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America.; Department of Biomedical Data Science, Stanford University, Stanford, California, United States of America.; Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America.; Department of Health Research and Policy and Medicine, Stanford University, Palo Alto, California, United States of America.; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America.; Center for Communications Science, RTI International, Seattle, Washington, United States of America.; Pacific Coast Psychiatric Associates, San Francisco, California, United States of America.; One Medical, San Francisco, California, United States of America.; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America.; Sutter Health Research Enterprise, Center for Health Systems Research, Walnut Creek, California, United States of America.; Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America.; Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America.
BT - PloS one
C5 - Healthcare Disparities; Measures
CP - 4
DO - 10.1371/journal.pone.0231743
IS - 4
JF - PloS one
LA - eng
M1 - Journal Article
N2 - INTRODUCTION: The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress. METHODS: Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results. RESULTS: Among 204 intervention participants (50.9 [SD, 12.2] years, 71% female, 72% non-Hispanic White, BMI 36.7 [6.9], PHQ-9 14.1 [3.2]), 31% (n = 63) had poor engagement, on average completing self-monitored weight in <3 of 46 weeks and <5 of 15 sessions. Among them, 50 (79%) discontinued the intervention by session 6 (week 8). Engaged participants (n = 141; 69%) self-monitored weight for 11-22 weeks, attended almost all 15 sessions, but showed variable treatment progress based on patterns of change in self-monitored weight and PHQ-9 scores over 12 months. Three patterns of weight change (%) represented minimal weight loss (n = 50, linear β1 = -0.06, quadratic β2 = 0.001), moderate weight loss (n = 61, β1 = -0.28, β2 = 0.002), and substantial weight loss (n = 12, β1 = -0.53, β2 = 0.005). Three patterns of change in PHQ-9 scores represented moderate depression without treatment progress (n = 40, intercept β0 = 11.05, β1 = -0.11, β2 = 0.002), moderate depression with treatment progress (n = 20, β0 = 12.90, β1 = -0.42, β2 = 0.006), and milder depression with treatment progress (n = 81, β0 = 7.41, β1 = -0.23, β2 = 0.003). The patterns diverged within 6-8 weeks and persisted throughout the intervention. Objectively measured weight loss and depression outcomes were significantly worse among participants with poor engagement or poor progress on either weight or PHQ-9 than those showing progress on both. CONCLUSIONS: Participants demonstrating poor engagement or poor progress could be identified early during the intervention and were more likely to fail treatment at the end of the intervention. This insight could inform individualized and timely optimization to enhance treatment efficacy. TRIAL REGISTRATION: ClinicalTrials.gov# NCT02246413.
PY - 2020
SN - 1932-6203; 1932-6203
T1 - Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: Within-treatment analysis in the RAINBOW trial
T2 - PloS one
TI - Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: Within-treatment analysis in the RAINBOW trial
U1 - Healthcare Disparities; Measures
U2 - 32315362
U3 - 10.1371/journal.pone.0231743
VL - 15
VO - 1932-6203; 1932-6203
Y1 - 2020
Y2 - Apr 21
ER -