The purpose of this study is to examine the association between patient outcomes and antidepressant treatment of people with depressive symptoms. The subjects of the study are elderly people, 65 years of age or older, living in the community who are enrolled in a social health maintenance organization (SHMO). The patient outcomes to be studied are health services utilization, health and functional status, including mortality, and quality of life. A stratified, random sample of five groups of SHMO enrollees living in ambulatory settings will be followed longitudinally: (1) Symptomatic, Treated--those with self reported symptoms of depression who are treated with antidepressant drugs (N=170). (2) Symptomatic, Not Treated--those with self-reported symptoms of depression not treated with antidepressant therapy (N = 130). (3) Not Symptomatic, Treated-this group includes consists those treated with antidepressant therapy without self reported symptoms of depression (N=100). (4) Not Symptomatic, Treated for Non-psychiatric Antidepressant-responsive Conditions-those who do not report any depressive symptoms but who are being treated for conditions that are responsive to antidepressant drugs (N=70). (5) Healthy Elderly--those without any self-reported symptoms of depression and not being treated with antidepressants (N = 130). Only those people who have 1-3 symptoms of major depression or who are asymptomatic will be included in these five subject groups; SHMO enrollees identified on the basis of the Diagnostic Interview Schedule as having major depression, dysthymia, or 4 or more symptoms of major depression will be excluded from the study. The cohort will be followed longitudinally, from March 1, 1993 to February 28, 1996. Although the social cost of major depressive disorders to the health care system and the individual is high in terms of health services utilization and social morbidity, depressive symptoms have been shown to extract an even greater toll because of the higher prevalence of this condition. There are very few studies of patient outcomes associated with antidepressant treatment of people with depressive symptoms in which the outcomes include measures of health services utilization, functional status, and qualify of life. There are even fewer such studies of community-based elderly people with depressive symptoms. This study addresses that need.
The specific aims of the proposed study are the following: (1) Treatment vs. Non Treatment of Symptomatic Elderly. Of the people with depressive symptoms, what are the differences in patient outcomes between those treated and not treated with antidepressant drugs, controlling for morbidity and sociodemographic characteristics? (2) Symptomatic, Treated vs. Healthy Elderly. How do the outcomes of elderly with depressive symptoms who are treated compare to those who are healthy.? (3) Within Group Comparisons of Patient Characteristics (Improved/Not Improved).
This specific aim addresses the need of clinicians to predict which patients with depressive symptoms are most likely to respond to antidepressant therapy. (4) Outcomes as a Function of Physician Diagnosis and Treatment.
This specific aim will examine the extent to which primary care physicians recognize depressive symptoms in older people. It will also investigate patient outcomes as a function of physician diagnosis and treatment.
| Zelterman, D; Curtsinger, J W (1995) Survival curves subjected to occasional insults. Biometrics 51:1140-6 |
