'Care managers' help depressed elderly reduce suicidal thoughts

An intervention that includes staffing doctors' offices with depression care managers helps depressed elderly patients reduce suicidal thoughts, a study funded by NIH's National Institute of Mental Health (NIMH) has found. Martha Bruce, Ph.D., Cornell University, Charles Reynolds, III, M.D., University of Pittsburgh, and colleagues report on the outcome of the intervention in three major Eastern U.S. metropolitan areas in the March 3, 2004 Journal of the American Medical Association.

Older Americans comprise 13 percent of the population but account for 18 percent of all suicides. The major risk factor for suicide in late life is major depression.

"Since most older Americans who kill themselves have seen their doctor within a month of the event, effectively treating depression in primary care is a preventive intervention that can save lives," noted NIMH Director Thomas Insel, M.D.

Reynolds and colleagues set out to demonstrate that by educating physicians and improving treatment up to guideline standards, a social worker, nurse or masters-level psychologist assigned to assist in depression management can significantly improve clinical outcomes. The "depression care managers" were assigned to 10 randomly selected primary care practices in greater Philadelphia, Pittsburgh and New York City. Each practice was paired with a similar practice, which served as a control by providing its "usual care" in the study, called PROSPECT (Prevention of Suicide in Primary care Elderly: Collaborative Trial).

In initial screenings over two years, about 12 percent of the primary care patients tested positive for depression. From these, 598, mostly females and two-thirds with major depression, were recruited into the study.

The care managers applied structured treatment guidelines: First, they offered patients the serotonin selective reuptake inhibitor (SSRI) or another antidepressant if clinically warranted. If a patient didn't want medica

Contact: Jules Asher
NIH/National Institute of Mental Health

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