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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)

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

hillary.bogner{at}uphs.upenn.edu

ABSTRACT

OBJECTIVE: Our a priori hypothesis was that depressed patients with diabetes in practices implementing a depression management program would have a decreased risk of mortality compared to depressed patients with diabetes in usual care practices.

RESEARCH DESIGN AND METHODS: Multi-site practice-randomized controlled trial PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) with patient recruitment from 5/99-8/01 and supplemented with a search of the National Death Index. Twenty primary care practices participated from New York City, Philadelphia, and Pittsburgh. In all, 584 participants who were identified though a two-stage, age-stratified (60–74; 75+) depression screening of randomly sampled patients and were classified as depressed with complete information on diabetes status are included in these analyses. Of all 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 Condition were less likely to have died during the 5-year follow-up interval than were depressed persons with diabetes 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 were depressed patients with diabetes in usual care practices.

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				B. D. Thombs and R. C. Ziegelstein Diabetes, Depression, and Death: A Randomized Controlled Trial of a Depression Treatment Program for Older Adults Based in Primary Care (PROSPECT): Response to Bogner et al. Diabetes Care, June 1, 2008; 31(6): e54 - e54. [Full Text] [PDF]