IMPACT OF PAIN INTERFERENCE ON TREATMENT OUTCOMES AMONG OLDER ADULTS WITH DEPRESSIVE AND ANXIETY SYMPTOMS RECEIVING COLLABORATIVE MENTAL HEALTH CARE

Abstract

Introduction Depression, anxiety and chronic pain are highly comorbid in the elderly population. These symptoms can interfere with daily activities and adversely affect quality of life. The mechanisms underlying the associations among pain and mental health symptoms are complex and likely bidirectional in nature. This interrelatedness between pain, depression and anxiety symptoms can often lead to diagnostic uncertainty and polypharmacy. Moreover, the literature points to less favorable outcomes among those receiving treatment for depression and anxiety who report comorbid pain. However, less is known about whether pain moderates outcomes among community-dwelling older adults engaged in care for more moderate symptomatology. The primary aim of the study was to examine if baseline pain interference with daily activities had an impact on treatment outcomes in elderly patients with depressive and anxiety symptoms at 3 months and 6 months. The sample consisted of low income, community-dwelling older adults with comorbid pain, depression and anxiety symptoms who were enrolled in a telephone-based collaborative care management program. Methods The sample included 519 older adults newly prescribed an antidepressant or benzodiazepine by a primary care provider and enrolled in the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program. The SUSTAIN program provides behavioral health services by telephone to enrollees in the Pennsylvania Department of Aging's pharmaceutical assistance program (PACE/PACENET). The PACE/PACENET program serves low and moderately low-income seniors. Patients who agree to participate in SUSTAIN complete comprehensive assessments of mental health symptoms, cognition, sleep, pain, and functional status by a health technician. The current study included those patients meeting criteria for clinically significant baseline mental health symptoms who agreed to engage in care management services delivered by a clinician (LSW or RN). Over the course of care management, patients received symptom and medication monitoring, brief behavioral therapy, and psychosocial support, and were connected to needed community resources. Summary reports were also sent to patients’ prescribers with recommendations for treatment planning (where indicated). Baseline clinical program data extracted for the current analyses included self-reported socio-demographics (age, financial status, gender), clinical symptoms (depressive [PHQ-9] and anxiety [GAD-7] symptoms), overall mental functioning (Veterans RAND 12-Item Health Survey [VR12]), and self-reported pain over the past 24?hours and 3 months. Pain interference was rated on a scale of 0 (no interference) to 10 (complete interference). Data on depression, anxiety, and overall mental health outcomes were also collected at 3 and 6-month follow-up. Bivariate analyses were run to examine associations among pain and various clinical and sociodemographic variables at baseline. Longitudinal, mixed effects models were run to examine the extent to which baseline pain moderated changes in depressive symptoms, anxiety symptoms, and overall mental functioning over time. Results Patients were on average 77.7 (SD 6.8) years old. The majority were female (86.7%), non-Hispanic white (92.9%), and reported having enough finances to “get along” (83.4%). Antidepressant or benzodiazepine was reported as the index medication for 59.3% and 40.7% of the patients, respectively. 51.4% reported pain interference with activities. Patients had a mean baseline score of 8.81 (SD 4.6) on the PHQ-9 (range=0-24), 4.74 (SD 4.4) on the GAD-7 (range=0-21), and 47.4 (SD 11.1) on overall mental functioning (range=4.85-72.85). Bivariate results revealed that greater baseline pain was significantly associated with lower financial status (p Conclusions The data suggest that in this sample of community-dwelling older adults enrolled in a state-sponsored pharmacy benefit and treatment support program, baseline pain interference did not impact treatment outcomes of depressive and anxiety symptoms over a period of 6 months. The findings suggest that a collaborative care program for depression and anxiety may be effective in reducing mental health symptoms even in the presence of self-reported pain interference with activities. This research was funded by: Commonwealth of Pennsylvania, Department of Aging, PACE Program, PACE/PACENET.