The role of medical comorbidity in outcome of major depression in primary care: the PROSPECT study.
OBJECTIVE
The authors described the influence of specific medical conditions on clinical remission and response of major depression (MDD) in a clinical trial evaluating a care-management intervention among older primary-care patients.


METHODS
Adults age 60 years and older were randomly selected and screened for depression. Participants were randomly assigned to Usual Care or to an Intervention with a depression care-manager offering algorithm-based care for MDD. In all, 324 adults meeting criteria for MDD were included in these analyses. Remission and response was defined by a score on the Hamilton Rating Scale for Depression <10 and by a decrease from baseline of > or =50%, respectively. Medical comorbidity was ascertained through self-report. Cognitive impairment was defined by a score <24 on the Mini-Mental State Exam (MMSE).


RESULTS
In Usual Care, rates of remission were faster in persons who reported atrial fibrillation (AF) than in persons who did not report AF and slower in persons who reported chronic pulmonary disease than in persons who did not report chronic pulmonary disease; rates of response were less stable in persons with MMSE <24 than in those with MMSE > or =24. In the Intervention condition, none of the specific chronic medical conditions were significantly associated with outcomes for MDD.


CONCLUSIONS
Because disease-specific findings were observed in persons who received Usual Care but not in persons who received more intensive treatment in the Intervention condition, our results suggest that the association of medical comorbidity and treatment outcomes for MDD may be determined by the intensity of treatment for depression.
Bogner
Hillary R
HR
Dept. of Family Practice and Community Medicine, Univ. of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA 19104, USA. bogner@mail.med.upenn.edu
Cary
Mark S
MS
Bruce
Martha L
ML
Reynolds
Charles F
CF
Mulsant
Benoit
B
Ten Have
Thomas
T
Alexopoulos
George S
GS
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011320:Primary Health Care; D011613:Psychotherapy / Q000379:methods*; D012074:Remission Induction; D011795:Surveys and Questionnaires; D016896:Treatment Outcome