Effectiveness of Problem-Solving Therapy for Older, Primary Care Patients With Depression: Results From the IMPACT Project

Purpose: We compared a primary-care-based psy-chotherapy, that is, problem-solving therapy for primary care (PST-PC), to community-based psycho-therapy in treating late-life major depression and dys-thymia. Design and Methods: The data here are from the IMPACT study, which compared collabora-tive care within a primary care clinic to care as usual in the treatment of 1,801 primary care patients, 60 years of age or older, with major depression or dysthymia. This study is a secondary data analysis (n = 433) of participants who received either PST-PC (by means of collaborative care) or community-based psychotherapy (by means of usual care). Results: Older adults who received PST-PC had more de-pression-free days at both 12 and between 12 and 24 months (b = 47.5, p,.001; b = 47.0, p,.001), and they had fewer depressive symptoms and better functioning at 12 months (bdep =0.36, p,.001; bfunc = 0.94, p,.001), than those who received community-based psychotherapy. We found no differences at 24 months. Implications: Results suggest that PST-PC as delivered in primary care set-tings is an effective method for treating late-life depression