Depression care reduces mortality in elderly patients

Depression care management for elderly patients eliminated the increase in mortality risk associated with major depression, a new study found.

Researchers screened patients age 60 and over for depression at 20 primary care practices in New York City, Philadelphia and Pittsburgh between May 1999 and August 2001. They selected 1,226 patients (396 with major depression, 203 with clinically significant minor depression and 627 not depressed) to follow through 2008 (a median follow-up of 8 years). Results were published by BMJ on June 5.

Patients with depression were randomized to usual care (educational sessions for primary care physicians and notification to the physicians of patients' depression status) or usual care plus an intervention. The intervention added education of patients' families and a depression care manager who worked in the primary care practices for two years. The care managers (social workers, nurses and psychologists) worked with physicians to recommend treatment (psychotherapy and/or antidepressants) and interacted with patients in person or by phone at scheduled intervals and as needed.

At the conclusion of follow-up, 405 patients had died. The patients with major depression who had been randomized to usual care were significantly more likely to have died than the patients without depression (hazard ratio [HR], 1.90; 95% CI, 1.57 to 2.31). However, patients with major depression who received the intervention had about the same mortality risk as patients without depression (HR, 1.09; 95% CI, 0.83 to 1.44). The study found no significant effect on mortality in patients with minor depression.

This study provides the first evidence from a randomized clinical trial that treatment of major depression can extend life, the study authors concluded. Patients in the intervention group received more antidepressant and psychotherapy treatment than those in usual care. The effects of the care manager's presence may have continued after the intervention ended, with clinicians being more sensitive to symptoms and skillful at managing depression, the authors suggested.

The study authors concluded that treatment of depression probably works on multiple pathways to interrupt the link between depression and mortality and that this study shows the importance of integrating depression care into chronic care management. Policy changes to facilitate this integration in a way that's acceptable to older patients and families are urgently needed, the authors concluded.