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Diabetes, Depression, and Death

A randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT)

¹ Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
² Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
³ Veterans Affairs Health Services Research and Development and National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, Michigan
⁴ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
⁵ Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York

Address correspondence and reprint requests to Hillary R. Bogner, MD, Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce St., 2 Gates Building, Philadelphia, PA 19104. E-mail: hillary.bogner{at}uphs.upenn.edu

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.

Abbreviations: CES-D, Centers for Epidemiologic Studies Depression scale • NDI, National Death Index • PROSPECT, Prevention of Suicide in Primary Care Elderly: Collaborative Trial

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