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Treatment Effects from UPBEAT: A Randomized Trial of Care Management for Behavioral Health Problems in Hospitalized Elderly Patients

Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Mental Illness Research Education and Clinical Center at the Philadelphia VA Medical Center, oslin{at}mail.med.upenn.edu

Richard Thompson, PhD

Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Mental Illness Research Education and Clinical Center at the Philadelphia VA Medical Center

Michael J. Kallan, MS

Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia

Thomas TenHave, PhD

Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia

Frederic C. Blow, PhD

Department of Psychiatry, University of Michigan, and the Ann Arbor VA Healthcare System

Roshan Bastani, PhD

University of California, Los Angeles, School of Public Health and Jonsson Comprehensive Cancer Center

Robert L. Gould, PhD

Department of Statistics, University of California, Los Angeles

Annette E. Maxwell, DrPH

University of California, Los Angeles, School of Public Health and Jonsson Comprehensive Cancer Center

Joel Rosansky, LCSW

VA Greater Los Angeles Healthcare System

William Van Stone, MD

VA Central Office, Washington, DC

Lissy Jarvik, MD, PhD

VA Greater Los Angeles Healthcare System, University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences and Neuropsychiatric Institute and Hospital

The purpose of this study was to examine the impact of the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) Program, an interdisciplinary mental health care management program, on the behavioral health symptoms of elderly veterans. Participants, 60 years and older, included 2637 veterans recruited from medical/surgical units who screened positively for significant depressive or anxiety symptoms and/or at-risk alcohol drinking. Participants were randomized to UPBEAT or to usual care. Primary outcomes were measured at baseline and at 6, 12, and 24 months. Participant nonadherence to the protocol was common and is a major limitation. There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point. Exploratory analyses suggested that among participants with more physical health problems, there were greater improvements in depressive symptoms in those assigned to UPBEAT care. Despite a theoretical and practically sound intervention, participation was low and treatment outcomes, while generally good, appeared unaffected by the addition of the program.

Key Words: depression • hospital • alcohol use • collaborative care

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