COPD affects 15% of older adults and is the fourth leading cause of death in the US. More than 20% of COPD patients have major depression. Patients with severe COPD live with daily physical discomfort, are forced to a compromised life style, and have to cope with demoralization caused by the knowledge of their inescapable deterioration and death. The pessimism, helplessness, and worthlessness of depression, lead to resignation and worsen their demoralization. Executive dysfunction occurs in about half of depressed COPD patients and reduces their ability to develop behavioral strategies to address their treatment needs and their life problems. These problems are compounded by the demanding treatment of COPD that requires active patient participation. The last thing that a depressed, demoralized, cognitively compromised, and physically weak patient wants to do is to pursue a consistent exercise program, go to doctors and treatment centers, and reengineer the social aspects of his/her life. As a consequence, they give up on treatment and other activities and experience a painful end of life. We developed an intervention (PST-AE) that integrates treatment adherence enhancement procedures (AE) with problem solving therapy (PST). PST-AE offers education and direct suggestions for improving treatment adherence and imparts behavioral strategies for meeting the patients'complex treatment needs, depressive symptoms, and disability. We hypothesize that PST-AE will reduce depression and disability and improve quality of life and adherence to treatment of COPD more than AE. We propose to test these hypotheses in 160 patients with major depression and severe COPD consecutively recruited from an inpatient Rehabilitation Hospital who will be randomly assigned to receive 14 sessions of PST-AE (N=80) or AE (N=80) and be systematically rated over 26 weeks. We target one of the most disabled and suffering segments of the population. We used, in our design, our research experience with depressed COPD patients, the PROSPECT multicenter study of primary care elderly patients, and the geriatric depression studies of our ACISR. If found effective, PST-AE can be broadly implemented, as it can be used by visiting nurse professionals after retraining. Beyond COPD, PST- AE may be a model of care for patients with a variety of chronic, debilitating disorders, who often develop depression, give up, and have a poor and often fatal outcome. As a major focus of PST-AE is improvement of treatment adherence, this approach to the care of depressed, medically ill patients can generate a practice model that has the ability to rapidly incorporate advances made in clinical science.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Interventions Committee for Disorders Related to Schizophrenia, Late Life, or Personality (ITSP)
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Niederehe, George T
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Weill Medical College of Cornell University
Schools of Medicine
New York
United States
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Alexopoulos, George S; Sirey, Jo Anne; Banerjee, Samprit et al. (2018) Two Interventions for Patients with Major Depression and Severe Chronic Obstructive Pulmonary Disease: Impact on Dyspnea-Related Disability. Am J Geriatr Psychiatry 26:162-171
Mace, Ryan A; Gansler, David A; Suvak, Michael K et al. (2017) Therapeutic relationship in the treatment of geriatric depression with executive dysfunction. J Affect Disord 214:130-137
Alexopoulos, George S; Sirey, Jo Anne; Banerjee, Samprit et al. (2016) Two Behavioral Interventions for Patients with Major Depression and Severe COPD. Am J Geriatr Psychiatry 24:964-974
Kiosses, Dimitris N; Alexopoulos, George S (2014) Problem-Solving Therapy in the Elderly. Curr Treat Options Psychiatry 1:15-26
Yohannes, Abebaw M; Alexopoulos, George S (2014) Depression and anxiety in patients with COPD. Eur Respir Rev 23:345-9
Morimoto, Sarah Shizuko; Alexopoulos, George S (2013) Cognitive deficits in geriatric depression: clinical correlates and implications for current and future treatment. Psychiatr Clin North Am 36:517-31
Alexopoulos, George S; Raue, Patrick J; Sirey, Jo Anne et al. (2008) Developing an intervention for depressed, chronically medically ill elders: a model from COPD. Int J Geriatr Psychiatry 23:447-53