Erfolgsfaktoren, Herausforderungen und Hemmnisse in der kollaborativen Versorgung depressiv erkrankter älterer Menschen: Ein qualitativ kontrastierender Fallvergleich der Patientenperspektive zur Evaluation der Studie GermanIMPACT (QualIMP)

Background: Treatment of depressive disorders in old age is hindered by several barriers, such as negative concepts of ageing, self-stigmatization, symptom overlays with somatic comorbidities and time pressure in primary care. Untreated depressive syndromes are more likely to become chronic, are risk factors for other diseases. Indeed, they are the main rea-son for the increase in the suicide rate in old age. To improve this condition, the so called collaborative care approach GermanIMPACT was evaluated in a cluster-randomized con-trolled study in Hamburg and Freiburg. In this approach non-medical therapists offered a complex stepped-care telephone intervention of monitoring, psychoeducation, behavioral activation, medication counseling and the mediation of problem-solving techniques. This intervention delivered by telephone was superior to the usual treatment by the family doc-tor. 25,6 percent of the intervention group showed a remission of depressive symptoms compared with 10,9 percent in the control group. Nevertheless, three quarters of the pa-tients in the intervention group did not achieve a satisfactory reduction in depression.
Question: Which patient- and intervention-specific moderators contribute to a successful intervention in the GermanIMPACT-study?
Methods: Problem-centered interviews with 26 patients from the intervention group were carried out. These were structured with a type-forming qualitative content analysis and ex-amined in a qualitative contrasting case comparison, regarding conducive and obstructive factors to the intervention and the symptom development.
Results: The telephone-intervention had a positive influence on the depressive symptoms, especially in individuals with late-onset depression, upbeat sense of activities, supportive contacts and limited comorbidity. In contrast, individuals with severe early onset depression could benefit subjectively in a variety of ways, but their depressive symptoms didn’t change.
Discussion: GermanIMPACT, in its current form as a conceptual low-threshold intervention, is suitable for moderately burdened individuals. Extending interventions could increase their effectiveness and improve the care situation of elderly depressed people.