title: Diabetes, depression, and death: a randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT).
abstract: OBJECTIVE
  We sought to test our a priori hypothesis that depressed patients with diabetes in practices implementing a depression management program would have a decreased risk of mortality compared with depressed patients with diabetes in usual-care practices.
  
  
  METHODS
  We used data from the multisite, practice-randomized, controlled Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT), with patient recruitment from May 1999 to August 2001, supplemented with a search of the National Death Index. Twenty primary care practices participated from the greater metropolitan areas of New York City, New York; Philadelphia, Pennsylvania; and Pittsburgh, Pennsylvania. In all, 584 participants identified though a two-stage, age-stratified (aged 60-74 or >or=75 years) depression screening of randomly sampled patients and classified as depressed with complete information on diabetes status are included in these analyses. Of the 584 participants, 123 (21.2%) reported a history of diabetes. A depression care manager worked with primary care physicians to provide algorithm-based care. Vital status was assessed at 5 years.
  
  
  RESULTS
  After a median follow-up of 52.0 months, 110 depressed patients had died. Depressed patients with diabetes in the intervention category were less likely to have died during the 5-year follow-up interval than depressed diabetic patients in usual care after accounting for baseline differences among patients (adjusted hazard ratio 0.49 [95% CI 0.24-0.98]).
  
  
  CONCLUSIONS
  Older depressed primary care patients with diabetes in practices implementing depression care management were less likely to die over the course of a 5-year interval than depressed patients with diabetes in usual-care practices.
authors: Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce St., 2 Gates Building, Philadelphia, PA 19104, USA. hillary.bogner@uphs.upenn.edu
authors: Hillary R
authors: HR
authors: Bogner
authors: Knashawn H
authors: KH
authors: Morales
authors: Edward P
authors: EP
authors: Post
authors: Martha L
authors: ML
authors: Bruce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003866:Depressive Disorder / Q000150:complications / Q000401:mortality / Q000628:therapy*; D048909:Diabetes Complications / Q000401:mortality / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011320:Primary Health Care / Q000458:organization & administration; D016019:Survival Analysis
references: Am J Epidemiol. 2005 Apr 1;161(7):652-60
references: 15781954
references: J Diabetes Complications. 2005 Mar-Apr;19(2):113-22
references: 15745842
references: Diabetes Care. 2005 Jun;28(6):1339-45
references: 15920049
references: Am J Geriatr Psychiatry. 2005 Sep;13(9):748-55
references: 16166403
references: Diabetes Care. 2005 Nov;28(11):2668-72
references: 16249537
references: Am J Geriatr Psychiatry. 2006 Jan;14(1):71-8
references: 16407584
references: Int J Geriatr Psychiatry. 2007 Feb;22(2):106-14
references: 17096458
references: Ann Intern Med. 2007 May 15;146(10):689-98
references: 17502629
references: J Neurosci Methods. 2005 Apr 30;143(2):209-16
references: 15814153
references: Diabetes Care. 2000 May;23(5):618-23
references: 10834419
references: Ann Epidemiol. 2001 Jan;11(1):46-50
references: 11164119
references: Health Care Financ Rev. 2000 Spring;21(3):65-91
references: 11481768
references: Psychosom Med. 2001 Jul-Aug;63(4):619-30
references: 11485116
references: J Psychosom Res. 2002 Oct;53(4):903-6
references: 12377301
references: Biol Psychiatry. 2003 Aug 1;54(3):248-61
references: 12893101
references: Biol Psychiatry. 2003 Aug 1;54(3):317-29
references: 12893107
references: Diabetes Care. 2003 Oct;26(10):2822-8
references: 14514586
references: JAMA. 2004 Mar 3;291(9):1081-91
references: 14996777
references: Ann Intern Med. 2004 Jun 15;140(12):1015-24
references: 15197019
references: Arch Gen Psychiatry. 2004 Oct;61(10):1042-9
references: 15466678
references: BMJ. 2004 Oct 23;329(7472):966-8
references: 15499115
references: J Psychiatr Res. 1975 Nov;12(3):189-98
references: 1202204
references: J Gerontol. 1982 Jan;37(1):91-9
references: 7053405
references: Control Clin Trials. 1986 Dec;7(4):267-75
references: 3802849
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: Control Clin Trials. 1989 Dec;10(4 Suppl):187S-194S
references: 2605967
references: Ann Intern Med. 1992 Jan 1;116(1):78-84
references: 1530753
references: J Clin Epidemiol. 1996 May;49(5):511-7
references: 8636724
references: Diabetes Care. 1996 Oct;19(10):1097-102
references: 8886555
references: Psychosom Med. 1997 May-Jun;59(3):241-50
references: 9178335
references: Behav Res Ther. 1997 Nov;35(11):1039-46
references: 9431735
references: Ann Intern Med. 1998 Oct 15;129(8):613-21
references: 9786808
references: J Occup Environ Med. 1998 Sep;40(9):808-13
references: 9777565
references: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references: 14399272
references: Milbank Q. 2004;82(4):661-87
references: 15595946
references: Lancet. 2005 Jan 8-14;365(9454):176-86
references: 15639301