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- Title
Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk.
- Authors
Gallo, Joseph; Hwang, Seungyoung; Joo, Jin; Bogner, Hillary; Morales, Knashawn; Bruce, Martha; Reynolds, Charles; Gallo, Joseph J; Joo, Jin Hui; Bogner, Hillary R; Morales, Knashawn H; Bruce, Martha L; Reynolds, Charles F 3rd
- Abstract
<bold>Background: </bold>Two-thirds of older adults have two or more medical conditions that often take precedence over depression in primary care.<bold>Objective: </bold>We evaluated whether evidence-based depression care management would improve the long-term mortality risk among older adults with increasing levels of medical comorbidity.<bold>Design: </bold>Longitudinal analyses of the practice-randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Twenty primary care practices randomized to intervention or usual care.<bold>Patients: </bold>The sample included 1204 older primary care patients completing the Charlson Comorbidity Index (CCI) and other interview questions at baseline.<bold>Intervention: </bold>For 2 years, a depression care manager worked with primary care physicians to provide algorithm-based care for depression, offering psychotherapy, increasing the antidepressant dose if indicated, and monitoring symptoms, medication adverse effects, and treatment adherence.<bold>Main Measures: </bold>Depression status based on clinical interview, CCI to evaluate medical comorbidity, and vital status at 8 years (National Death Index).<bold>Key Results: </bold>In the usual care condition, patients with the highest levels of medical comorbidity and depression were at increased risk of mortality over the course of the follow-up compared to depressed patients with minimal medical comorbidity [hazard ratio 3.02 (95% CI, 1.32 to 8.72)]. In contrast, in intervention practices, patients with the highest level of medical comorbidity and depression compared to depressed patients with minimal medical comorbidity were not at significantly increased risk [hazard ratio 1.73 (95% CI, 0.86 to 3.96)]. Nondepressed patients in intervention and usual care practices had similar mortality risk.<bold>Conclusions: </bold>Depression management mitigated the combined effect of multimorbidity and depression on mortality. Depression management should be integral to optimal patient care, not a secondary focus.
- Subjects
MENTAL depression; PRIMARY care; OLDER people; SUICIDE; COMORBIDITY; DIAGNOSIS of mental depression; THERAPEUTICS; SUICIDE prevention; CITALOPRAM; SECOND-generation antidepressants; COMPARATIVE studies; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MORTALITY; PRIMARY health care; PSYCHOTHERAPY; RESEARCH; RESEARCH funding; EVIDENCE-based medicine; DISEASE management; PROFESSIONAL practice; EVALUATION research; RANDOMIZED controlled trials
- Publication
JGIM: Journal of General Internal Medicine, 2016, Vol 31, Issue 4, p380
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-015-3524-y