COPD-related depression, dyspnea disability improved by personalized program
MedwireNews: A personalized intervention program for depression and chronic obstructive pulmonary disease (COPD) resulted in higher remission rates than treatment as usual in a prospective clinical trial.
The personalized intervention program also reduced depressive symptoms and dyspnea-related disability to a greater degree than usual care over the 28 weeks of the study, say US researchers.
"This intervention may serve as a care model for people with both depression and a medical illness with a deteriorating course, who often neglect their own care," George Alexopoulos, from Weill Cornel Medical College Institute for Geriatric Psychiatry in White Plains, New York, USA, and colleagues write in The British Journal of Psychiatry.
The personalized intervention for depression and COPD (PID-C) used in the trial consisted of nine 30-minute sessions delivered by care managers over a period of 28 weeks. The intervention targeted patient-specific barriers to nonadherence, such as misconceptions about their illness and confusion over medication regimens, and was performed initially at discharge from an acute inpatient pulmonary rehabilitation unit, and then every few weeks in the patients' homes.
Of 898 COPD patients consecutively screened, 138 had unipolar major depression, defined as a score of 14 or greater on the 17-item Hamilton Rating Scale for Depression (HRSD). Of these, 67 were allocated to the intervention group and 71 to a treatment-as-usual group.
At the end of the 28-week study period, 88 patients had HRSD scores of more than 7, meaning that they had failed to remit. Patients in the PID-C group were twice as likely as those in the usual care group to go into remission (HRSD ≤7), with a hazard ratio of 2.18. The number needed to treat was 3.83 in favor of the intervention.
Furthermore, declines in HRSD and dyspnea-related disability (assessed using the Pulmonary Functional Status and Dyspnea Questionnaire) were greater in patients given the PID-C than usual care over the course of the study.
Importantly, "these benefits lasted 6 months after the intervention end," the researchers note.
"This study is unique because it targeted patients with depression at the most severe end of a deteriorating medical illness with a bleak prognosis evidenced by their high mortality," Alexopoulos and team observe.
A high attrition rate was observed, with 25% and 17% of patients in the intervention and usual care groups, respectively, dropping out during the treatment phase of the trial. A further 18% and 17% in each group, respectively, died.
As only brief training is required, the intervention could be easily implemented by organizations looking after people with COPD, such as home healthcare and rehabilitation services, the researchers say.
"A next step may be to deliver and study PID-C in a group format and facilitate its dissemination," they suggest.
By Sara Freeman, medwireNews Reporter