Remission in Depressed Geriatric Primary Care Patients: A Report From the PROSPECT Study

• Published in: The American journal of psychiatry Vol. 162; no. 4; pp. 718 - 724
• Main Authors: Alexopoulos, George S., Katz, Ira R., Bruce, Martha L., Heo, Moonseong, Have, Thomas Ten, Raue, Patrick, Bogner, Hillary R., Schulberg, Herbert C., Mulsant, Benoit H., Reynolds, Charles F.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01-04-2005; American Psychiatric Association
• Subjects: Aged; Algorithms; Biological and medical sciences; Care management; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Elder care; Elderly people; Emotional disorders; Female; Geriatric psychology; Health Services for the Aged - statistics & numerical data; Humans; Male; Medical sciences; Mental depression; Mental health; Patient Care Management - methods; Patient Care Planning; Patient Compliance; Practice Guidelines as Topic; Practice Patterns, Physicians; Prevention. Health policy. Planification; Primary care; Primary health care; Primary Health Care - methods; Probability; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Referral and Consultation; Remission; Research Design - standards; Risk assessment; Risk Factors; Social psychiatry. Ethnopsychiatry; Treatment Outcome; United States; United States Agency for Healthcare Research and Quality - standards; USA; United States; North America; America; Social environment; Hope hopelessness; Primary health care; Multicenter study; Mental health; Activity; Waiting time; Functional capacity; Health policy; Remission; Therapeutic schedule; Public health; Human; Mood disorder; Daily living; Attitude; Treatment efficiency; Depression; Emotion emotionality; Recommendation; Symptomatology; Treatment; Follow up study; Predictive factor; Elderly; Comparative study
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.162.4.718

OBJECTIVE: 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. METHOD: Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (≥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. RESULTS: 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. CONCLUSIONS: 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.