The Wish to Die and 5-Year Mortality in Elderly Primary Care Patients

• Published in: The American journal of geriatric psychiatry Vol. 18; no. 4; pp. 341 - 350
• Main Authors: Raue, Patrick J., Ph.D, Morales, Knashawn H., Sc.D, Post, Edward P., M.D., Ph.D, Bogner, Hillary R., M.D., M.S.C.E, Have, Thomas Ten, Ph.D, Bruce, Martha L., Ph.D., M.P.H
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-04-2010; Elsevier Limited
• Subjects: Aged; Attitude to Death; Citalopram - therapeutic use; Depression - drug therapy; Depression - mortality; Depression - psychology; Depression - therapy; Female; Geriatric Assessment; geriatrics; Health Services for the Aged - statistics & numerical data; Humans; Internal Medicine; Male; Middle Aged; mortality; primary care; Primary Health Care - statistics & numerical data; Psychotherapy; Risk Factors; Suicidal ideation; wish to die; wish to die; mortality; geriatrics; primary care; Suicidal ideation
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1097/JGP.0b013e3181c37cfe

Objectives The authors examined the impact of the wish to die on mortality over a 5-year period, stratified by baseline depressive status (i.e., major, minor, and no depression diagnosis). The authors also examined whether a depression care management intervention would minimize these relationships. Design Longitudinal analyses of the practice-randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Setting Twenty primary care practices from New York City, Philadelphia, and Pittsburgh. Participants One thousand two hundred two participants were identified through two-stage, age-stratified (60–74 years; 75 years and older) depression screening of randomly sampled participants. Intervention Practices randomized to Care Management Intervention or Usual Care conditions. Measurements Vital status at 5 years using the National Death Index. Results Rates of the wish to die were 29% (major depression), 11% (minor depression), and 7% (no depression). In Usual Care, the wish to die was associated with an increased risk of 5-year mortality across depressive status (adjusted hazard ratios ranging from 1.62 to 1.71). In intervention practices, this association was greater among the no depression (adjusted hazard ratio 1.64) compared with major depression group (adjusted hazard ratio 0.68). Conclusions The wish to die was associated with mortality in the usual care of elderly primary care patients, suggesting that the wish to die has clinical significance and may be worth assessing even in patients without other evidence of depression. This association was not observed among depressed patients located in primary care practices that implemented the PROSPECT intervention, suggesting potential long-term benefits of treatment and management of depression.