Care Management Proves to Reduce Depression in Older Primary Care Patients

A trained depression care manager may be the key factor in treating older adults for depression in a primary care setting, new research shows.

Researchers from universities in New York and Pennsylvania have just released findings of Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). The study, conducted over a two-year period, found that the addition of a trained depression professional increased the number of patients receiving treatment, led to a higher remission rate of depression, and reduced suicidal thoughts. Here are some of the findings of the study:

- A decline in suicidal ideation that was 2.2 times greater in patients receiving care from a primary care physician and a depression care manager;

- Remission of depression happening faster and increasing between 18 and 24 months in patients receiving treatment for depression;

- And a greater number of patients in the intervention group with major depression achieving remission or “near absence of symptoms.”

The trial followed 599 patients 60 and older with depression at 20 different primary care practices in New York and Pennsylvania who were randomly given usual care by a physician or PROSPECT intervention. Participants in the PROSPECT group were assigned a trained social worker, nurse or psychologist who assisted the primary care physician in offering treatment that were in accordance to accepted guidelines, monitoring treatment response, and providing follow-up.

"Almost one in 10 older adults in the United States has some form of depression, and one-fifth among them contemplates suicide,” said Dr. George S. Alexopoulos, director of the Institute of Geriatric Psychiatry at NewYork-Presbyterian Hospital/Westchester Division, professor of psychiatry at Weill Cornell Medical College and lead author of the study. “Two-thirds of these patients are treated by primary care physicians. Sadly, their depression is often inadequately treated due to the primary care physician's time constraints and the patient's reluctance to discuss their symptoms and adhere to treatment. The critical finding of the PROSPECT study is that adding a trained care manager to primary care practices increases the number of depressed older patients who receive treatment and improves their outcomes, not only in the short term, but over two years.”

Other members of the research team include several more doctors from New York-Presbyterian Hospital and Weill Cornell, and doctors from the University of Pittsburgh, the University of Pennsylvania, and the University of Toronto. Results of the study were also published in the American Journal of Psychiatry.