Oral Papers: Collaborative Care & Community C-L II
Background: There is limited evidence for collaborative care for depression in people living with HIV (PLWH) and existing clinical trials have excluded patients with high acuity. We sought to understand the factors associated with response/remission when collaborative care was implemented with broad inclusionary criteria.
Methods: Collaborative care was universally implemented from July 1st 2016 to June 30th 2017 in an urban HIV clinic. Response (50% decrease in PHQ-9 score)/remission (PHQ-9< 5) rates, and sociodemographic and clinical correlates were collected. Social connectedness was measured by the Friendship Scale and collected on a subset of patients. Frequencies and percentages for categorical variables and means and standard deviations for continuous variables were evaluated across response/remission categories. All study procedures were approved by the local IRB (IRB#15-00252).
Results: 1493 patients were screened for depression, 594 reported moderate-severe depressive symptoms, and 416 had at least one follow-up re-measurement during the study period. 23% responded, 21.5% remitted and 44.5 either responded or remitted. Having a low income (30K-50K) [relative to very low income (0K-30K)] was correlated with a high response and remission rate (p=0.026) and receiving Medicare with a high remission rate (p=0.033). Receiving Medicaid (p=0.006) and having comorbid generalized anxiety disorder (p=0.022) or a substance use disorder (p=0.004) [specifically, cocaine (p=0.005), amphetamine (p=0.015), or alcohol use disorder (0.038)] were correlated with low response and remission rates. Greater social connectedness was correlated with higher remission rates (p=0.002).
Discussion: Response and remission rates are higher than one previously published clinical trial (Pyne 2011) and lower than another (Sowa 2016). In contrast to previously published findings (Sowa 2016) we found that substance abuse interfered with achieving response or remission. Our finding of the impact of social connectedness in collaborative care depression outcomes are novel. Implementing interventions to address substance abuse, anxiety, and social isolation in depressed PLWH could lead to higher response or remission rates in a collaborative care setting.
Conclusion: Wide scale implementation of collaborative care is effective for depression in PLWH and targeting modifiable correlates has the potential to improve depression outcomes.
Pyne JM, Fortney JC, Curran GM, Tripathi S, Atkinson JH, Kilbourne AM, Hagedorn HJ, Rimland D, Rodriguez-Barradas MC, Monson T, Bottonari KA, Asch SM, Gifford AL. Effectiveness of collaborative care for depression in human immunodeficiency virus clinics. Arch Intern Med. 2011 Jan 10;171(1):23-31.
Sowa NA, Bengtson A, Gaynes BN, Pence BW. Predictors of depression recovery in HIV-infected individuals managed through measurement-based care in infectious disease clinics. J Affect Disord. 2016 Mar 1;192:153-61.