Problem-Solving Therapy for People With Major Depression and Chronic Obstructive Pulmonary Disease
Condition: Pulmonary Disease, Chronic Obstructive; Depression
MeSH terms: Lung Diseases; Pulmonary Disease, Chronic Obstructive; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This study will evaluate the effectiveness of problem-solving therapy combined with treatment
      adherence procedures in treating older people with major depression and chronic obstructive
      pulmonary disease.
    

Detailed description: 
      Depression is a serious illness that affects a person's mood, thoughts, and physical
      well-being. Common symptoms of depression include persistent feelings of anxiety, guilt, or
      hopelessness; irregular sleep and appetite patterns; lethargy; disinterest in previously
      enjoyed activities; excessive irritability and restlessness; suicidal thoughts; and inability
      to concentrate. Depression often occurs in the presence of one or more other disorders. For
      example, depression is reported to be at a higher rate in people with chronic obstructive
      pulmonary disease (COPD) than in the general population. COPD is a disease in which the lungs
      are damaged, making it difficult to breathe. Symptoms most commonly include chronic coughing
      and shortness of breath. A primary cause of COPD is cigarette smoking. Following a prescribed
      treatment plan is important for managing COPD. Unfortunately, people with COPD often do not
      adhere to their treatment plans. Being depressed makes adherence even more difficult. This
      study will evaluate the effectiveness of problem-solving therapy integrated with
      adherence-enhanced procedures (PSA) in treating older people with major depression and COPD.

      Participants in this open label study will be randomly assigned to one of two groups: PSA or
      PID-C. In PSA, a therapist will teach participants problem-solving strategies focusing on
      treatment adherence, depressive symptoms, and disability. Participants will learn behaviors
      and solutions to help cope with these problems. In PID-C, a therapist will teach participants
      to identify obstacles to treatment adherence and to discover ways to overcome them. The
      treatment sessions for both groups will be initiated at the inpatient Pulmonary Unit of Burke
      Rehabilitation Hospital and will continue in the participants' homes. All participants will
      receive two treatment sessions during hospitalization, eight weekly sessions following
      discharge, and four monthly sessions after that. While hospitalized at Burke, participants
      will also undergo an assessment interview for 1.5 hours and another interview for 20 minutes
      2 weeks following the initial assessment. Interviews lasting 1.5 hours will also occur in the
      homes of the participants at Weeks 10, 14, and 26 after discharge from Burke. All assessments
      will focus on depression severity, level of general functioning, and COPD treatment
      adherence.
    

Intervention name(s): Problem Solving-Rx Adherence (PSA); PID-C
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In PSA, a therapist teaches the participant to identify problems related to depression, functioning, and treatment adherence; to generate multiple solutions; and to choose and implement one or more of those solutions.; In PID-C, a therapist identifies obstacles to treatment adherence and helps the participant overcome those obstacles.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: COPD; Geriatric Depression; Problem-Solving Therapy; Treatment Adherence