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Effectiveness of Problem-Solving Therapy for Older, Primary Care Patients With Depression: Results From the IMPACT Project

Correspondence: Address correspondence to Patricia A. Arean, PhD, University of California San Francisco, Department of Psychiatry, 401 Parnassus Avenue, San Francisco, CA 94143. E-mail: pata{at}lppi.ucsf.edu

Purpose: We compared a primary-care-based psychotherapy, that is, problem-solving therapy for primary care (PST-PC), to community-based psychotherapy in treating late-life major depression and dysthymia. Design and Methods: The data here are from the IMPACT study, which compared collaborative care within a primary care clinic to care as usual in the treatment of 1,801 primary care patients, 60 years of age or older, with major depression or dysthymia. This study is a secondary data analysis (n = 433) of participants who received either PST-PC (by means of collaborative care) or community-based psychotherapy (by means of usual care). Results: Older adults who received PST-PC had more depression-free days at both 12 and between 12 and 24 months (β = 47.5, p <.001; β = 47.0, p <.001), and they had fewer depressive symptoms and better functioning at 12 months (β_dep = –0.36, p <.001; β_func = –0.94, p <.001), than those who received community-based psychotherapy. We found no differences at 24 months. Implications: Results suggest that PST-PC as delivered in primary care settings is an effective method for treating late-life depression.

Key Words: Depression • Geriatrics • Primary care • Psychotherapy