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Therapeutics
Managed depression care reduces mortality in older adults with major depression

http://dx.doi.org/10.1136/ebmh.11.1.16

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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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    Footnotes

    Footnotes

    • Competing interests: JW has consulted for 3CM, an LLC that collaborates with medical groups, health plans and federal entities to develop and implement collaborative care programmes for patients with mental illness; is co-director of the MacArthur Initiative on Depression and Primary care; is a member of the Mental Health Integration Workgroup of the Office of VA Patients Care Services.