title: Does a Depression Management Program Decrease Mortality in Older Adults with Specific Medical Conditions in Primary Care? An Exploratory Analysis.
abstract: OBJECTIVE
  To determine whether treating depression decreases mortality from various chronic medical conditions.
  
  
  METHODS
  Long-term follow-up of multisite-practice randomized controlled trial (Prevention of Suicide in Primary Care Elderly: Collaborative Trial).
  
  
  METHODS
  Twenty primary care practices randomized to intervention or usual care.
  
  
  METHODS
  Individuals aged 60 and older identified through depression screening of random patients (N=1,226).
  
  
  METHODS
  For 2 years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm-based care for depression.
  
  
  METHODS
  Mortality risk based on a median follow-up of 98 months (range 0.8-116.4 months) through 2008; chronic medical conditions ascertained through self-report.
  
  
  RESULTS
  For heart disease, persons with major depression were at greater risk of death, whether in usual-care or intervention practices. Older adults with major depression and diabetes mellitus in practices randomized to the intervention condition (hazard ratio=0.47, 95% confidence interval=0.24-0.91) were less likely to die. For other medical conditions, the point estimates for risk of death in persons with major depression were all in the direction of indicating lower risk in intervention practices but did not reach statistical significance.
  
  
  CONCLUSIONS
  Older adults with depression and medical comorbidity pose a significant clinical and public health challenge. Evidence was found of a statistically significant intervention effect on mortality for diabetes mellitus in persons with major depression.
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.affiliation: Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jin H
authors.initials: JH
authors.lastname: Joo
authors.affiliation: Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Seungyoung
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, New York.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.affiliation: School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.affiliation: Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease / Q000401:mortality*; D003695:Delivery of Health Care / Q000379:methods*; D003863:Depression / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011613:Psychotherapy / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents
keywords: depression; medical comorbidity; primary care; randomized clinical trial