CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial

Abstract

BackgroundDepression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option.Methods/designCASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants.The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners.The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care.A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial.DiscussionResults will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care.Trial registrationISRCTN45842879 (24 July 2012).

Life adversity in depressed and non-depressed older adults: A cross-sectional comparison of the brief LTE-Q questionnaire and life events and difficulties interview as part of the CASPER study

“…Events characterized by declining health and disability, shown in this study to be the most prevalent in late life, may increase the risk of depression through reduced engagement in valued leisure activities, socializing and a decrease in the availability of emotional support (Blazer, 2003a). Studies in primary care are therefore trialling behavioural interventions for older adults with depression (Overend, Lewis, Bailey et al, 2014) to increase the amount of positive reinforcement they gain from functionally equivalent activities in which they are able to engage.…”

Increased medical cost metrics for patients 50 years of age and older in the collaborate care model of treatment for depression

“…Like other chronic health issues, depression management costs are an economic burden in health‐care systems worldwide . In addition, depression treatment costs may vary based on age.…”

“…Overend et al . reported that outpatient care costs were significantly greater and psychotherapy costs lower in patients older than 65 years compared to younger age groups . Expenditures on the management of mental health disorders among older patients, particularly for depression, has been shown to differ according to type of health care center.…”

Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study

“…In the CASPER plus (CollAborative care for Screen-Positive EldeRs with major depression) trial, [42][43][44] the BA intervention was acceptable for many of the older adults with depression and could readily be delivered over the telephone, following a face-to-face meeting. This approach may be able to reduce the stigma of the label of mental illness and resolve misconceptions around antidepressant medication prescribed by GPs.…”

“…The intervention was built on the literature, the research team's previous experience 39,42,76 and consensus achieved in an expert group.…”