Context Depression and arthritis are disabling and common health problems in
late life. Depression is also a risk factor for poor health outcomes among
Objective To determine whether enhancing care for depression improves pain and
functional outcomes in older adults with depression and arthritis.
Design, Setting, and Participants Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative
Treatment (IMPACT), a randomized controlled trial of 1801 depressed older
adults (≥60 years), which was performed at 18 primary care clinics from
8 health care organizations in 5 states across the United States from July
1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at
Intervention Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving
Treatment in Primary Care).
Main Outcome Measures Depression, pain intensity (scale of 0 to 10), interference with daily
activities due to arthritis (scale of 0 to 10), general health status, and
overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months.
Results In addition to reduction in depressive symptoms, the intervention group
compared with the usual care group at 12 months had lower mean (SE) scores
for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference,
−0.53; 95% confidence interval [CI], −0.92 to −0.14; P = .009), interference with daily activities due to arthritis
(4.40 [0.18] vs 4.99 [0.17]; between-group difference, −0.59; 95% CI,
−1.00 to −0.19; P = .004), and interference
with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group
difference, −0.26; 95% CI, −0.41 to −0.10; P = .002). Overall health and quality of life were also enhanced among
intervention patients relative to control patients at 12 months.
Conclusions In a large and diverse population of older adults with arthritis (mostly
osteoarthritis) and comorbid depression, benefits of improved depression care
extended beyond reduced depressive symptoms and included decreased pain as
well as improved functional status and quality of life.