The overarching goal of this amended proposal entitled "Long-term effects of depression care on services use and mortality in late life" is to assess the long-term effect on use of health care services and mortality of a primary care practice-based intervention for depression. Our work has shown that after 5 years of follow-up, older adults with major depression in practices randomized to the practice-based intervention condition were less likely to die over the follow-up interval. A goal of this competing renewal proposal to MH065539 is to extend our 5 year mortality follow-up to 8 years and to add claims data, supplementing available data on depression and depression interventions over 2 years with dates and causes of death from the National Center for Health Statistics (National Death Index Plus) and with health services claims data from the Center for Medicaid and Medicare Services.
Specific aims of this study are: (1) to assess how the effectiveness of a practice-based intervention (intent-to-treat analysis) and increasing intensity of different types of depression treatment (as-treated analysis) in reducing all-cause mortality over the course of an 8-year follow-up interval differs between older adults with major depression, clinically significant minor depression, or suicidal ideation versus older adults without significant depression or suicidal ideation;and (2) to assess how the effectiveness of a practice-based intervention (intent-to-treat analysis) and increasing intensity of depression treatment (as- treated analysis) in reducing use of health care services over the course of an 8-year follow-up interval. To accomplish these aims, we will capitalize on screening, clinical assessment, treatment, and follow-up assessments of 1,226 persons which occurred for up to 2 years in PROSPECT, building on our work with 5- year mortality follow-up data. We propose to study the relationship of major depression, other depressive syndromes, and suicidal ideation with long-term outcomes (use of health services and mortality) in the context of an intervention directed at the practice level that increased individual-level exposure of older patients to antidepressant medication and psychotherapy
Policy changes to improve reimbursement for collaborative care, to increase the use of care management, and to improve access to medications in primary care settings increase the urgency for information on the long- term individual and societal consequences of practice-based interventions. Our project is consistent with the NIMH Strategic Plan to reduce premature mortality among persons with mental illness.
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