# Impact of Collaborative Care on Depression in Patients Aged 60+: A Secondary Analysis of the GermanIMPACT Study on Behavioural Activation

## TL;DR

This study found that implementing self-care and spirituality activities in collaborative care helps reduce depression in older adults.

## Contribution

The study identifies specific behavioral activation activities linked to improved depression outcomes in older patients.

## Key findings

- 66% of planned activities were successfully implemented in the collaborative care model.
- Self-care/spirituality activities were associated with better PHQ-9 outcomes (OR 1.540; p = 0.048).
- Planned but not implemented activities worsened depression symptoms (OR 1.16; p = 0.007).

## Abstract

Depressive disorders are highly prevalent among older adults (60+) in Europe. Activating these patients was a core component of the GermanIMPACT study, which evaluated collaborative care in a cluster-randomized primary care setting. The intervention group showed a significant improvement in PHQ-9 remission. The aim of this secondary analysis was to investigate which activities were planned and whether their implementation or non-implementation was associated with depressive symptoms (PHQ-9) after 12 months. Behavioural activation data were collected by the care managers. A categorization for activity type (collected as free text) and activity implementation status was developed. The association of successfully implemented activities, planned-not-implemented activities, and the number of activities per patient with the 12-month PHQ-9 total score was calculated using logistic regressions (adjusted for age, gender, living situation/baseline PHQ-9). A total 2188 activities were planned for 136 patients; 66% were successfully implemented. Mean age was 71 (±7) years (78% female; 52% living alone). Activities focusing on “self-care/spirituality” improved the PHQ-9 outcome (OR 1.540; p = 0.048), while planned-not-implemented activities overall worsened it (OR 1.16; p = 0.007). Patient activation is key to treating depressive symptoms in old age. Particularly ‘self-care/spirituality’ activities could be planned, and organizational activities should be closely supported.