title: The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial.
abstract: BACKGROUND
  Few studies have tested the effects of a depression intervention on the risk for death associated with depression.
  
  
  OBJECTIVE
  To test whether an intervention to improve depression care can modify the risk for death.
  
  
  METHODS
  Practice-based, randomized, controlled trial.
  
  
  METHODS
  20 primary care practices in New York, New York, and Philadelphia and Pittsburgh, Pennsylvania.
  
  
  METHODS
  1226 randomly sampled patients identified through a 2-stage, age-stratified (60 to 74 years and > or =75 years) depression screening.
  
  
  METHODS
  Depression care manager working with primary care physicians to provide algorithm-based care.
  
  
  METHODS
  Depression status based on clinical interview and vital status at 5 years by using the National Death Index.
  
  
  RESULTS
  At baseline, 396 patients met criteria for major depression and 203 patients met criteria for clinically significant minor depression. After a median follow-up of 52.8 months, 223 patients died. Patients with depression in intervention practices were less likely to have died than those in usual care practices (adjusted hazard ratio, 0.67 [95% CI, 0.44 to 1.00]). Risk for death was reduced in patients with major depression (adjusted hazard ratio, 0.55 [CI, 0.36 to 0.84]) but not in patients with clinically significant minor depression (adjusted hazard ratio, 0.97 [CI, 0.49 to 1.92]). The benefit seemed to be almost entirely attributable to a reduction in deaths due to cancer.
  
  
  CONCLUSIONS
  The mechanism for an effect on deaths due to cancer is unclear. Depression status, cause of death, and vital status might have been misclassified.
  
  
  CONCLUSIONS
  Older primary care patients with major depression in practices that implemented depression care management were less likely to die over a 5-year period than were patients with major depression in usual care practices. The effect seemed to be limited to deaths due to cancer. The mechanism for such an effect is unclear and warrants further investigation. ClinicalTrials.gov registration number: NCT00000367.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. galloj@uphs.upenn.edu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
authors.forename: Edward P
authors.initials: EP
authors.lastname: Post
authors.forename: Julia Y
authors.initials: JY
authors.lastname: Lin
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
mesh_terms: D000368:Aged; D002423:Cause of Death; D003863:Depression / Q000401:mortality / Q000628:therapy*; D003866:Depressive Disorder / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D015143:Philadelphia / Q000453:epidemiology; D011320:Primary Health Care; D012307:Risk Factors