DIABETES, DEPRESSION, AND DEATH: A RANDOMIZED CONTROLLED TRIAL OF A DEPRESSION TREATMENT PROGRAM FOR OLDER ADULTS BASED IN PRIMARY CARE (PROSPECT)

  1. Hillary R Bogner, M.D., M.S.C.E. (hillary.bogner{at}uphs.upenn.edu)1,
  2. Knashawn H Morales, S.c.D.2,
  3. Edward P Post, M.D., Ph.D.3 and
  4. Martha L Bruce, Ph.D., M.P.H.4
  1. 1Department of Family Medicine and Community Health,
  2. 2Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
  3. 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
  4. 4Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York

    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.

    Footnotes

      • Received May 21, 2007.
      • Accepted August 18, 2007.

    This Article

    1. Diabetes Care
    1. All Versions of this Article:
      1. dc07-0974v1
      2. 30/12/3005 most recent