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 setting"""""""". 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 with a few weeks of their death, intervening at the doctor's office may be live 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 in depression and suicidal ideation will be implemented. We expect that will 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 a 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 and older selected from an age-stratified, two- stage sampling design and followed for two years. The groups 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 and 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 hypothesis 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 #
5R01MH059381-02
Application #
2891143
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
1999-06-01
Budget End
2000-05-31
Support Year
2
Fiscal Year
1999
Total Cost
Indirect Cost
Name
University of Pittsburgh
Department
Psychiatry
Type
Schools of Medicine
DUNS #
053785812
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
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
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
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
Gallo, Joseph J; Bogner, Hillary R; Morales, Knashawn H et al. (2007) The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial. Ann Intern Med 146:689-98
Bogner, Hillary R; Bruce, Martha L; Reynolds 3rd, Charles F et al. (2007) The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study. Int J Geriatr Psychiatry 22:922-9
Bogner, Hillary R; Lin, Julia Y; Morales, Knashawn H (2006) Patterns of early adherence to the antidepressant citalopram among older primary care patients: the prospect study. Int J Psychiatry Med 36:103-19

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