Effect of Improving Depression on Pain and Function in Older Adults with Arthritis
Summary written by Kevin Fontaine, Ph.D.
Osteoarthritis (OA) and depression are both common, disabling health problems in older adults. These conditions may reciprocally interact to promote poor functional and health outcomes, and impaired psychological well-being. However, little is known about the effects of improving depression in older adults who also have OA. As part of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial, Lin and associates (Journal of the American Medical Association, 290:2428-2434, 2003) analyzed data from a large sample of depressed older adults with OA to examine the effects of treating the depression on their pain, function, and quality of life.
Methods: IMPACT is a randomized controlled trial of 1,801 depressed older adults aged = 60 years performed at 18 primary care clinics across the US. Fifty six percent of the sample (N = 1,001) reported arthritis at baseline. These participants were randomized to either depression care management (i.e., antidepressant medication and/or 6-8 sessions of psychotherapy) or usual care (i.e., antidepressant medication and referral to mental health services). Outcomes included depression, pain intensity, functional status, and quality of life assessed at baseline, 3, 6, and 12 months.
Results: At 12 months patients in the depression care management group we over two times more likely to report a 50% reduction in depressive symptoms than patients in the usual care group (41% vs. 18%). Moreover, compared to usual care, patients who received depression care management also reported significant reductions in pain (p = .009), as well as improvements in functional status (ps = .004 & .002), and quality of life (p = .005) at 12 months.
Conclusions: The benefits of treating depression not only reduced depressive symptoms but also decreased pain and improved functional status and quality of life in older adults with arthritis.
Editorial Comments: This study provides support for providing specific and focused depression care in older adults with co-existing arthritis. That is, the effect of improving depression status extends well beyond improving psychological status; it also improves important health and functional outcomes related to the arthritis. Beyond arthritis, the results of this study imply that depression should be routinely assessed and, if warranted, treated in late life to promote both improved psychological functioning and improved functional status and quality of life, irrespective of the presence of co-morbid conditions such as arthritis.
