Telephone-Base Monitoring Plus Care Management Improved Mental Health Functioning

Shahrzad Mavandadi, PhD Research Health Science Specialist and Investigator Veterans Integrated Services Network 4 Mental Illness Research, Education, and Clinical Center Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Interview with:
Shahrzad Mavandadi, PhD
Research Health Science Specialist and Investigator
Veterans Integrated Services Network 4 Mental Illness Research,
Education, and Clinical Center
Corporal Michael J. Crescenz Veterans Affairs Medical Center
Philadelphia, Pennsylvania

 Medical Research: What is the background for this study?

Dr. Mavandadi: Mental health (MH) conditions are underidentified and undertreated in later life.  This is particularly true among subgroups of older adults who are more vulnerable to developing mental health issues, have poor access to specialty care, and are less responsive to treatment and therapy.  Thus, we sought to evaluate longitudinal MH outcomes among low-income, community-dwelling older adults enrolled in an evidence-based, collaborative mental health care management service (i.e., the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program).  The SUSTAIN program integrates mental health with primary care (which is where the majority of behavioral health conditions in later life are managed) and provides standardized, measurement-based, software-aided MH assessment and connection to community resources to older adults by telephone.

While there is a strong evidence base for the efficacy of collaborative care models for me conditions, little is known about the amount or level of patient and provider support that is needed to achieve optimal behavioral health outcomes.  Thus, we specifically examined outcomes among older adults randomized to one of two program arms of varying intensity: MH symptom monitoring alone or mental health symptom monitoring plus MH care management.   MH care management involved care managers who provided education, counseling, and decision support to patients and their primary care providers, a licensed mental health clinician who supervised the care managers, and the use of an algorithm to help guide pharmacological and non-pharmacological treatment plans.  The sample consisted of 1018 older adults prescribed an antidepressant or anxiolytic by their non-behavioral health providers who presented with clinically significant symptoms at intake.

Medical Research: What are the main findings?

Dr. Mavandadi: Our main findings indicated that, compared to those assigned to mental health symptom monitoring alone, individuals assigned to symptom monitoring plus MH care management showed greater improvements in overall mental health functioning and depressive and anxiety symptoms across time (i.e., 3 and 6 month follow-up).  Additional analyses also showed that compared to those in monitoring alone, individuals with moderate to severe baseline symptoms randomized to care management also were more likely to achieve remission at follow-up.

Medical Research: What should clinicians and patients take away from your report?

Dr. Mavandadi: Evidence-based mental health care management strategies can be successfully delivered, by telephone, across a large geographical region to community-dwelling older adults in a feasible and scalable way.  Moreover, a more intense level of collaborative MH care (i.e., symptom monitoring plus care management) designed to address multiple MH symptoms and non-MH needs is related to better outcomes when compared to symptom monitoring alone.  Not only do depression and anxiety symptoms improve, but overall MH functioning is positively impacted as well.  The results also suggest that structured MH care management in which individuals are monitored and the information is provided to the prescriber can serve to augment primary care and pharmacological management.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Mavandadi: Future work would benefit from studying the specific components of care management that are most effective in positively impacting patient outcomes.  Examining subgroups of patients (e.g., those with mild vs. moderate to severe mental health symptoms at intake) is also important, as these groups may differ with regard to the need for and response to various treatment strategies.   Analysis of the cost effectiveness and economic aspect of these findings also is needed, particularly among subgroups of older adults who might be more vulnerable to health issues and increased health care utilization.


Mavandadi S, Benson A, DiFilippo S, Streim JE, Oslin D. A Telephone-Based Program to Provide Symptom Monitoring Alone vs Symptom Monitoring Plus Care Management for Late-Life Depression and Anxiety: A Randomized Clinical Trial. JAMA Psychiatry.Published online November 11, 2015. doi:10.1001/jamapsychiatry.2015.2157.

Shahrzad Mavandadi, PhD (2015). Telephone-Base Monitoring Plus Care Management Improved Mental Health Functioning 

Last Updated on November 17, 2015 by Marie Benz MD FAAD