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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH065539-04
Application #
7061300
Study Section
Special Emphasis Panel (ZRG1-BBBP-5 (01))
Program Officer
Niederehe, George T
Project Start
2003-04-01
Project End
2008-03-31
Budget Start
2006-04-01
Budget End
2008-03-31
Support Year
4
Fiscal Year
2006
Total Cost
$279,855
Indirect Cost
Name
University of Pennsylvania
Department
Family Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
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
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
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
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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