Citation

Gallo JJ, Morales KH, Bogner HR, Raue PJ, Zee J, Bruce ML, Reynolds III CF. BMJ 2013; 346(7911).

Copyright

(Copyright © 2013, BMJ Publishing Group)

DOI

10.1136/bmj.f2570

PMID

unavailable

Abstract

OBJECTIVE: To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression.

DESIGN: Long term follow-up of multi-site practice randomized controlled trial (PROSPECT - Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Setting: 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. Participants: 1226 participants identified between May 1999 and August 2001 through a two stage, age stratified (60-74; ≥75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of patients who screened negative. Intervention: For two years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm based care for depression, offering psychotherapy, increasing antidepressant dose if indicated, and monitoring symptoms, adverse effects of drugs, and adherence to treatment. This paper reports the long term follow-up. Main outcome measure: Mortality risk based on a median follow-up of 98 (range 0.8-116.4) months through 2008.

RESULTS: In baseline clinical interviews, 396 people were classified as having major depression, 203 had clinically significant minor depression, and 627 did not meet criteria for depression. At follow-up, 405 patients had died. Patients with major depression in usual care were more likely to die than were those without depression (hazard ratio 1.90, 95% confidence interval 1.57 to 2.31). In contrast, patients with major depression in intervention practices were at no greater risk than were people without depression (hazard ratio 1.09, 0.83 to 1.44). Patients with major depression in intervention practices, relative to usual care, were 24% less likely to have died (hazard ratio 0.76, 0.57 to 1.00; P=0.05). Preliminary data on cause of death are provided. No significant effect on mortality was found for minor depression.

CONCLUSIONS: Older adults with major depression in practices provided with additional resources to intensively manage depression had a mortality risk lower than that observed in usual care and similar to older adults without depression. Trial registration: Clinical trials NCT00000367.

Language: en

Keywords

Humans; Risk Factors; United States; Aged; Female; Male; Middle Aged; adult; human; Severity of Illness Index; Depression; suicide; Suicide; female; male; epidemiology; aged; Health Behavior; Algorithms; Philadelphia; Disabled Persons; New York City; psychotherapy; depression; Delivery of Health Care; randomized controlled trial; Primary Health Care; cause of death; mortality; Follow-Up Studies; major depression; clinical trial; Antidepressive Agents; Psychotherapy; psychology; health behavior; risk factor; article; major clinical study; primary medical care; controlled study; antidepressant agent; health care delivery; priority journal; middle aged; organization and management; follow up; primary health care; multicenter study; algorithm; disabled person; self care; drug dose increase; Self Care; statistics and numerical data; randomized controlled trial (topic); Medication Adherence; severity of illness index; multicenter study (topic); medication compliance