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

Public Health Relevance

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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Mental Health Services in MH Specialty Settings (SRSP)
Program Officer
Niederehe, George T
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Johns Hopkins University
Other Health Professions
Schools of Public Health
United States
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Gallo, Joseph J; Hwang, Seungyoung; Joo, Jin Hui et al. (2016) Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk. J Gen Intern Med 31:380-6
Bogner, Hillary R; Joo, Jin H; Hwang, Seungyoung et al. (2016) Does a Depression Management Program Decrease Mortality in Older Adults with Specific Medical Conditions in Primary Care? An Exploratory Analysis. J Am Geriatr Soc 64:126-31
Joo, Jinhui; Hwang, Seungyoung; Gallo, Joseph J (2016) Death Ideation and Suicidal Ideation in a Community Sample Who Do Not Meet Criteria for Major Depression. Crisis 37:161-5
Hwang, Seungyoung; Jayadevappa, Ravishankar; Zee, Jarcy et al. (2015) Concordance Between Clinical Diagnosis and Medicare Claims of Depression Among Older Primary Care Patients. Am J Geriatr Psychiatry 23:726-34
Gallo, Joseph J; Morales, Knashawn H; Bogner, Hillary R et al. (2013) Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ 346:f2570
Pérez-Zepeda, Mario Ulises; Arango-Lopera, Victoria Eugenia; Wagner, Fernando A et al. (2013) Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study. Int J Geriatr Psychiatry 28:1260-9
Bogner, Hillary R; Morales, Knashawn H; Reynolds 3rd, Charles F et al. (2012) Course of depression and mortality among older primary care patients. Am J Geriatr Psychiatry 20:895-903
González, Hector M; Tarraf, Wassim; Whitfield, Keith et al. (2012) Vascular depression prevalence and epidemiology in the United States. J Psychiatr Res 46:456-61
Gonzalez, Hector M; Tarraf, Wassim; Whitfield, Keith E et al. (2010) The epidemiology of major depression and ethnicity in the United States. J Psychiatr Res 44:1043-51
Raue, Patrick J; Morales, Knashawn H; Post, Edward P et al. (2010) The wish to die and 5-year mortality in elderly primary care patients. Am J Geriatr Psychiatry 18:341-50

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