Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study.
OBJECTIVE
The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) evaluated the impact of a care management intervention on suicidal ideation and depression in older primary care patients. This is the first report of outcomes over a 2-year period.


METHODS
Study participants were patients 60 years of age or older (N=599) with major or minor depression selected after screening 9,072 randomly identified patients of 20 primary care practices randomly assigned to provide either the PROSPECT intervention or usual care. The intervention consisted of services of 15 trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 24 months.


RESULTS
Compared with patients receiving usual care, those receiving the intervention had a higher likelihood of receiving antidepressants and/or psychotherapy (84.9%-89% versus 49%-62%) and had a 2.2 times greater decline in suicidal ideation over 24 months. Treatment response occurred earlier on average in the intervention group and increased from months 18 to 24, while no appreciable increase in treatment response occurred in the usual care group during the same period. Among patients with major depression, a greater number achieved remission in the intervention group than in the usual-care group at 4 months (26.6% versus 15.2%), 8 months (36% versus 22.5%), and 24 months (45.4% versus 31.5%). Patients with minor depression had favorable outcomes regardless of treatment assignment.


CONCLUSIONS
Sustained collaborative care maintains high utilization of depression treatment, reduces suicidal ideation, and improves the outcomes of major depression over 2 years.
Alexopoulos
George S
GS
Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Rd., White Plains, NY 10605, USA. gsalexop@med.cornell.edu
Reynolds
Charles F
CF
Bruce
Martha L
ML
Katz
Ira R
IR
Raue
Patrick J
PJ
Mulsant
Benoit H
BH
Oslin
David W
DW
Ten Have
Thomas
T
D000368:Aged; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002423:Cause of Death; D003866:Depressive Disorder / Q000401:mortality / Q000523:psychology / Q000628:therapy; D003865:Major Depressive Disorder / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D000092864:Suicide Prevention
D000928:Antidepressive Agents