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Managed depression care reduces mortality in older adults with major depression

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Joseph J Gallo, MD, MPH

Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA 19104, USA; galloj@uphs.upenn.edu

QUESTION

Question:

Does managed care for depression reduce mortality in older adults?

Patients:

1226 older adults (⩾60 years) identified through depression screening (Centers for Epidemiologic Studies Depression (CES-D) scale score >20, or previous depressive episodes or treatment) of a randomly selected age-stratified sample of people registered in 20 primary care practices. Assessment with the Structured Clinical Interview for DSM-IV Disorders Axis I (SCID-I) diagnosed 32% (396 people) with DSM-IV major depression, and 17% (203 people) with clinically significant minor depression (modified DSM-IV criteria: 4 depression symptoms, Hamilton Depression Rating Scale score ⩾10, symptoms lasting ⩾4 weeks). Main exclusion criteria: Mini-Mental State Examination score ⩾18, non-English speaking.

Setting:

20 primary care practices in New York and Pennsylvania, USA; May 1999 to August 2001.

Intervention:

Managed care or usual care. Managed care involved a depression care manager working with physicians to provide care according …

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