Background Parkinson’s disease (PD) is frequently complicated by co-occurring psychiatric problems, such as depression and anxiety, that negatively affect the course and management of the illness. Yet, in the majority of cases, these psychiatric comorbidities are neither recognized nor treated to remission. The primary purpose of this study was to identify and describe barriers to mental health care utilization for people with PD. Secondary objectives included the assessment of attitudes and preferences regarding the need for mental health services in the PD community and the acceptability of tele-health interventions as a method for improving access and quality of care. Methods Seven hundred sixty-nine people with PD completed an anonymous cross-sectional questionnaire assessing barriers to mental health care utilization in this medical population. Respondents were drawn from a national sample. Results Commonly endorsed barriers to mental health care utilization in PD reflect the patients’ incomplete understanding of mental health problems, access issues, and illness-specific concerns, as well as the inadequate screening and detection of psychiatric complications by medical providers, and the need for more effective treatments in this medical population. Several demographic, medical, and psychiatric variables also influenced the likelihood of accessing mental health care. Interest in tele-health approaches to mental health treatment was high and, in several instances, correlated with perceived barriers to mental health care utilization. Conclusions People with PD may encounter a multitude of barriers that impede their pursuit of mental health care. Clinical implications are discussed and further research is needed to replicate and extend these findings.

Objective The purpose of this study was to examine predictors of treatment response to cognitive-behavioral therapy (CBT) for depression in Parkinson’s disease (PD). Methods The sample comprised 80 depressed (DSM-IV criteria) adults with PD [60% male] and their caregivers who participated in an NIH-sponsored randomized-controlled trial of CBT vs. clinical monitoring from April 2007 until July 2010. Individually-administered CBT was provided to people with PD for 10 weeks, modified to address the unique needs of the medical population, and supplemented with up to 4 separate caregiver educational sessions. Treatment response was defined a priori as a rating of depression much improved or very much improved on the Clinical Global Impression-Improvement Scale or ≥ 50% reduction in the baseline Hamilton Depression Rating Scale score. It was hypothesized (a priori) that caregiver participation in treatment, motor disability, psychiatric comorbidity, and executive functioning would be significant predictors of response to CBT at end-of-treatment (week 10) and short-term follow-up (week 14). Results At week 10, caregiver participation was the only significant predictor of treatment response in the CBT group. At week 14, both caregiver participation and executive functioning predicted response to CBT. Treatment group, baseline depression severity, executive functioning, motor disability, psychiatric comorbidity, marital status, and caregiver burden were also related to change in depression scores, for all participants, in secondary and exploratory models. Conclusions Caregiver participation may enhance acute treatment response to psychosocial interventions for depression in PD. Further research is needed to extend and replicate these findings.

The purpose of this paper is to describe neuropsychological outcomes in people with Parkinson’s disease (PD) following their participation in an NIH-sponsored, randomized-controlled trial of cognitive-behavioral treatment for depression. Improvements in mood were associated with modest gains in verbal memory and executive functioning, over the 10-week treatment period, and accounted for greater variance in neuropsychological outcomes at the end-of-treatment, than other known correlates of cognitive functioning in PD, such as disease severity, age, and education. Baseline working memory and executive skills were also associated with depression improvement over time.

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