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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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    Supplementary materials

    • web only notes 11/1/16

      This study was a secondary analysis of data from the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Practices were matched into pairs based on a number of characteristics before randomisation by coin toss. One limitation of this study is the potential for deaths to be missed if they were not recorded on the NDI Plus database. However, the database has been shown previously to have a high sensitivity (over 90%).

    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.