The study was designed in response to the NIMH RFA inviting research to """"""""test models of depression recognition and treatment to prevent and reduce suicidal behavior in older patients in primary care settings"""""""". Elderly suicide most frequently occurs in the context of mild to moderate depression. In primary care patients, suicidal ideation is a risk factor for suicide and has been identified almost exclusively in patients with depressive symptoms and signs. Since most suicide victims are seen by their primary care physicians within a few weeks of their death, intervening at the doctor's office may be life saving. This study will investigate the effectiveness of an intervention aimed at improving the recognition of suicidal ideation and depression by the practices and facilitating the implementation of a treatment algorithm based on the AHCP guidelines. The linchpin of the intervention is the use of Depression Specialists (DS) who will collaborate with the physicians and help them to increase recognition of depression, offer timely and appropriately targeted treatment recommendations and encourage patients to adhere to treatment. In addition, procedures aimed at educating patients, families and physicians on depression and suicidal ideation will be implemented. We expect that this approach will lead to a reduction of depressive symptomatology and suicidal ideation and behavior and generate a practice model that has the ability to incorporate the advances of our clinical science. The study will be conducted by the Intervention Research Centers (IRC) of Cornell, University of Pennsylvania, and University of Pittsburgh. The intervention will be offered in 6 primary care practices from 3 geographic areas (metropolitan and suburban New York, Philadelphia, and Pittsburgh) and its impact will be contrasted to that of 6 comparable practices offering usual care. Data will come from a representative sample of patients aged 60 years an older selected through an age-stratified, two-stage sampling design and followed for two years. The group will consist of 1,200 subjects and comprise patients with depressive symptoms and signs (CES-D(11; estimated total N=920; per Center N=307) and a random sample of patients without significant depressive symptomatology (CES-D(11;estimated total N=280; per Center N=93). Beyond direct systematic clinical assessment of patients, information will be obtained on health services utilization from practice-based medical records an on cause of death from death certificates. Data will also be collected to document the impact of intervention on patient care, and on physician knowledge, attitudes, and satisfaction and test hypotheses derived from preliminary studies of the three IRCs.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH059366-02
Application #
2891141
Study Section
Special Emphasis Panel (ZMH1-CRB-B (08))
Program Officer
Pearson, Jane L
Project Start
1998-09-30
Project End
2003-05-31
Budget Start
1999-09-01
Budget End
2000-05-31
Support Year
2
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Weill Medical College of Cornell University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
201373169
City
New York
State
NY
Country
United States
Zip Code
10065
Ghesquiere, Angela R; Park, Mijung; Bogner, Hillary R et al. (2014) The effect of recent bereavement on outcomes in a primary care depression intervention study. Am J Geriatr Psychiatry 22:1555-64
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
Gilman, Stephen E; Bruce, Martha L; Ten Have, Thomas et al. (2013) Social inequalities in depression and suicidal ideation among older primary care patients. Soc Psychiatry Psychiatr Epidemiol 48:59-69
Gilman, Stephen E; Fitzmaurice, Garrett M; Bruce, Martha L et al. (2013) Economic inequalities in the effectiveness of a primary care intervention for depression and suicidal ideation. Epidemiology 24:14-22
Wallace, Meredith L; Dombrovski, Alexandre Y; Morse, Jennifer Q et al. (2012) Coping with health stresses and remission from late-life depression in primary care: a two-year prospective study. Int J Geriatr Psychiatry 27:178-86
Joo, Jin Hui; Morales, Knashawn H; de Vries, Heather F et al. (2010) Disparity in use of psychotherapy offered in primary care between older african-american and white adults: results from a practice-based depression intervention trial. J Am Geriatr Soc 58:154-60
Wallace, Meredith L; Anderson, Stewart J; Mazumdar, Sati (2010) A stochastic multiple imputation algorithm for missing covariate data in tree-structured survival analysis. Stat Med 29:3004-16
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
Bao, Yuhua; Post, Edward P; Ten, Thomas R et al. (2009) Achieving effective antidepressant pharmacotherapy in primary care: the role of depression care management in treating late-life depression. J Am Geriatr Soc 57:895-900
Alexopoulos, George S; Reynolds 3rd, Charles F; Bruce, Martha L et al. (2009) Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry 166:882-90

Showing the most recent 10 out of 36 publications