my personal edition > depression > news


  E-Mail this DGReview to a colleague

DGReview

Scheduled Depression Care Management by Trained Clinicians Reduces Suicidal Ideation and Depression in Older Patients

Use of scheduled depression care management by trained clinicians can reduce their risk of suicidal ideation and depression symptoms in older primary care patients diagnosed with depression.

"The impact of the intervention on depressive symptoms was greater among patients with major depression than for patients with mild depression unless suicidal ideation was also present," report Charles F. Reynolds III, MD, University of Pittsburgh, Pittsburgh, Pennsylvania, United States, and colleagues.

They compared usual care with a practice-based depression care intervention in 598 patients with depression and suicidal ideation enrolled in the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) conducted at 20 primary care practices in the United States.

The intervention group received care from social workers, nurses and psychologists who were trained in the management of depression, and were supervised by psychiatrists, to provide scheduled personal or telephone contact, and to monitor depressive symptoms, medication adverse effects and patient adherence to treatment. Depressive symptoms were determined by reduction from baseline in the Hamilton Depression Rating Scale (HAM-D).

The 320 patients in the intervention group and the 278 in the usual care group had similar sociodemographic characteristics and depression diagnosis or severity, and ranged in age from 60 to 94 years. Overall, 66.2% of the study population had severe depression while 29.4% of the intervention group and 20.1% of the usual care group reported suicidal ideation.

After 4 months of follow up the rates of suicidal ideation had declined by 12.9% points in the intervention group compared with 3.0% points in the usual care group. At 8- and 12-months, the rates of suicidal ideation were similar between groups.

In the intervention group, HAM-D scores were 7.4 at 4 months, 8.2 at 8 months, and 8.8 at 12 months compared with 3.9, 6.2, and 7.2, respectively, in the usual care group. Measurements of response to treatment mirrored these findings, while remission from depression was significantly higher than in the usual care group in the intervention group at 4-months, but similar at 8- and 12-months.

These findings, "demonstrated that an intervention consisting of guideline treatment managed by a master's-level clinician is both feasible and effective in significantly reducing suicidal ideation in geriatric patients suffering depression in primary care," the authors conclude.
JAMA 2004;291:1081-1091.

E-Mail this DGReview to a colleague

To print, use this version