Prevention of major depression in complex medically ill patients: preliminary results from a randomized, controlled trial.
BACKGROUND
Depression is highly prevalent in patients with physical illness and is associated with a diminished quality of life and poorer medical outcomes.


OBJECTIVE
The authors evaluated whether a multifaceted intervention conducted by a psychiatric consultation-liaison nurse could reduce the incidence of major depression in rheumatology inpatients and diabetes outpatients with a high level of case complexity.


METHODS
Of 247 randomized patients, the authors identified 100 patients with a high level of case complexity at baseline and without major depression (65 rheumatology and 35 diabetes patients). Patients were randomized to usual care (N=53) or to a nurse-led intervention (N=47). Main outcomes were the incidence of major depression and severity of depressive symptoms during a 1-year follow-up, based on quarterly assessments with standardized psychiatric interviews.


RESULTS
The incidence of major depression was 63% in usual-care patients and 36% in the intervention group. Effects of intervention on depressive symptoms were observed in outpatients with diabetes but not in rheumatology inpatients.


CONCLUSIONS
These preliminary results based on subgroup analysis suggest that a multifaceted nurse-led intervention may prevent the occurrence of major depression in complex medically ill patients and reduce depressive symptoms in diabetes outpatients.
de Jonge
Peter
P
Dept. of Psychiatry; University of Groningen, P.O. Box 30.001; 9700 RB Groningen, The Netherlands. peter.de.jonge@med.umcg.nl
Hadj
Fatima Bel
FB
Boffa
Daria
D
Zdrojewski
Catherine
C
Dorogi
Yves
Y
So
Alexander
A
Ruiz
Juan
J
Stiefel
Friedrich
F
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000451:nursing / Q000517:prevention & control* / Q000523:psychology; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D005356:Fibromyalgia / Q000523:psychology*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology; D011568:Psychiatric Nursing; D011613:Psychotherapy; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000523:psychology*; D012803:Sick Role; D016896:Treatment Outcome