Remission in depressed geriatric primary care patients: a report from the PROSPECT study. Am J Psychiatry 162: 718-724

Department of Psychiatry, Weill Medical College of Cornell University, New York, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 04/2005; 162(4):718-24. DOI: 10.1176/appi.ajp.162.4.718
Source: PubMed


This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists.
Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (> or =60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months.
First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety.
Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.

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    • "These findings underscore the importance of screening for suicidal risk and depression, at the primary care level. A number of collaborative steppedcare management programmes targeting older primary care clients with chronic physical illness using algorithm-driven treatment of depression have shown that suicide ideation is sustainably reduced among the participants after completion of the programme, in addition to effective treatment of depression, for instance, the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) (Alexopoulos et al., 2005, 2009). "
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    • "The disorder leads to negative consequences such as a poor quality of life, impairment in the activities of daily living, impaired cognition and increased risk of death (Barca et al., 2010, 2011a; Bergdahl et al., 2005; Lyketsos et al., 2003). It can be successfully treated with drugs or non-drug interventions , and it is therefore important to detect depression in elderly patients (Alexopoulos et al., 2005; Reynolds et al., 2005). "
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