title: Course of depression and mortality among older primary care patients.
abstract: BACKGROUND
  : Depression is a treatable illness that disproportionately places older adults at increased risk for mortality.
  
  
  OBJECTIVE
  : We sought to examine whether there are patterns of course of depression severity among older primary care patients that are associated with increased risk for mortality.
  
  
  METHODS
  : Our study was a secondary analysis of data from a practice-based randomized controlled trial within 20 primary care practices located in greater New York City, Philadelphia, and Pittsburgh.
  
  
  METHODS
  : The study sample consisted of 599 adults aged 60 years and older recruited from primary care settings. Participants were identified though a two-stage, age-stratified (60-74 years; older than 75 years) depression screening of randomly sampled patients. Severity of depression was assessed using the 24-item Hamilton Depression Rating Scale (HDRS).
  
  
  METHODS
  : Longitudinal analysis via growth curve mixture modeling was carried out to classify patterns of course of depression severity across 12 months. Vital status at 5 years was ascertained via the National Death Index Plus.
  
  
  RESULTS
  : Three patterns of change in course of depression severity over 12 months were identified: 1) persistent depressive symptoms, 2) high but declining depressive symptoms, 3) low and declining depressive symptoms. After a median follow-up of 52.0 months, 114 patients had died. Patients with persistent depressive symptoms were more likely to have died compared with patients with a course of high but declining depressive symptoms (adjusted hazard ratio 2.32, 95% confidence interval [1.15-4.69]).
  
  
  CONCLUSIONS
  : Persistent depressive symptoms signaled increased risk of dying in older primary care patients, even after adjustment for potentially influential characteristics such as age, smoking status, and medical comorbidity.
authors: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA. hillary.bogner@uphs.upenn.edu
authors: Hillary R
authors: HR
authors: Bogner
authors: Knashawn H
authors: KH
authors: Morales
authors: Charles F
authors: CF
authors: Reynolds
authors: Mark S
authors: MS
authors: Cary
authors: Martha L
authors: ML
authors: Bruce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic / Q000523:psychology*; D012307:Risk Factors; D012720:Severity of Illness Index