Journal Article

Diabetes, Depression, and Death: A randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT)

Bogner, Hillary R, Post, Edward P, Bruce, Martha L, Morales, Knashawn H

2007

Overview

OBJECTIVE:--We sought to test our a priori hypothesis that depressed patients with diabetes in practices implementing a depression management program would have a decreased risk of mortality compared with depressed patients with diabetes in usual-care practices. RESEARCH DESIGN AND METHODS--We used data from the multisite, practice-randomized, controlled Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT), with patient recruitment from May 1999 to August 2001, supplemented with a search of the National Death Index. Twenty primary care practices participated from the greater metropolitan areas of New York City, New York; Philadelphia, Pennsylvania; and Pittsburgh, Pennsylvania. In all, 584 participants identified though a two-stage, age-stratified (aged 60-74 or >=75 years) depression screening of randomly sampled patients and classified as depressed with complete information on diabetes status are included in these analyses. Of the 584 participants, 123 (21.2%) reported a history of diabetes. A depression care manager worked with primary care physicians to provide algorithm-based care. Vital status was assessed at 5 years. RESULTS:--After a median follow-up of 52.0 months, 110 depressed patients had died. Depressed patients with diabetes in the intervention category were less likely to have died during the 5-year follow-up interval than depressed diabetic patients in usual care after accounting for baseline differences among patients (adjusted hazard ratio 0.49 [95% CI 0.24-0.98]). CONCLUSIONS:--Older depressed primary care patients with diabetes in practices implementing depression care management were less likely to die over the course of a 5-year interval than depressed patients with diabetes in usual-care practices.

• Publisher: American Diabetes Association
• Subject: Aged / Aged, 80 and over / Biological and medical sciences / Care and treatment / Clinical trials / complications / Complications and side effects / death / Depression / Depression - complications / Depression - mortality / Depression - therapy / Depression, Mental / Depressive Disorder / Depressive Disorder - complications / Depressive Disorder - mortality / Depressive Disorder - therapy / Diabetes / Diabetes Complications / Diabetes Complications - mortality / Diabetes Complications - psychology / Diabetes. Impaired glucose tolerance / Diagnosis / elderly / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / epidemiology / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Female / Health aspects / Humans / Male / Medical sciences / Mental depression / Metabolic diseases / Middle Aged / Miscellaneous / Mortality / New York / Older people / organization & administration / patients / Pennsylvania / Pennsylvania - epidemiology / physicians / Primary care / Primary Health Care / Primary Health Care - organization & administration / psychology / Public health. Hygiene / Public health. Hygiene-occupational medicine / randomized clinical trials / Risk factors / risk reduction / screening / suicide / Survival Analysis / therapy / Wellness programs