The overarching goal of this study is to assess mortality of depressive syndromes in older adults in relation to overall death rates as well as in relation to deaths from specific causes, especially cardiovascular disease, while accounting for baseline and time-varying cardiovascular risk factors and other potentially influential personal and clinical characteristics. We will compare death rates among a representative sample of older persons who participated in an intervention trial designed to increase the number of older adults who receive appropriate depression treatment, such as antidepressant medications and psychotherapy. The study sample is enriched with older primary care patients with major and minor depression (n = 719) participating in an intervention trial, making it possible to study the impact of treatment on mortality risk associated with depression.
Specific aims of this study are: (1) to estimate the relative risk of all-cause mortality among older primary care patients with major depression and clinically significant minor depression compared to patients without significant depression after a 3-year follow-up interval, accounting for potentially influential personal and clinical characteristics; and, (2) to assess whether varying intensity of depression treatment is associated with different all-cause mortality after a 3-year follow-up interval. To accomplish these aims, we will capitalize on screening, clinical assessment, treatment, and follow-up assessments which have occurred for up to 2 years in PROSPECT (the """"""""Prevention of Suicide in Primary Care Elderly: Collaborative Trial""""""""). PROSPECT is a collaborative multi-site intervention study funded by the NIMH in primary care practices have been randomized into one of two treatment conditions: (1) treatment as usual (n = 597 patients); and (2) a guideline management intervention (n = 620 patients). In all, 1,217 patients, including all patients who screened positive for depression and a random sample of patients who screened negative, have been enrolled in the 2-year longitudinal study and clinically evaluated for DSM-IV major depression, minor depression, and dysthymia. In PROSPECT, 719 patients met criteria for depression treatment. The adequacy of depression treatment is assessed for all 1,217 patients regardless of diagnosis. Our proposal seeks support for identifying the follow-up vital status of the participants (using the National Death Index) and, for the persons who have died, determining primary and underlying causes of death using data from NDI Plus and primary care medical records. What we learn from this follow-up will help design interventions that are specifically targeted to decrease mortality among older adults with depression that is frequently associated with concurrent medical conditions such as diabetes mellitus and hypertension.
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