Study reveals need for engaging primary care practices as partners in developing mental health services for older patients

Older patients with major depression whose primary care physicians team with depression care managers are 45% less likely to die within a 5-year time period than older adults with major depression who receive their care in primary care practices where there are no depression care managers.

This study, conducted by researchers at the University of Pennsylvania School of Medicine, appears in the current issue of the Annals of Internal Medicine.

"The results of this study reveal the need for engaging primary care practices as partners in developing mental health services for older patients," says Joseph Gallo, MD, MPH, Associate Professor of Family Medicine and Community Health at Penn, and lead author of the paper.

The practice-based, randomized, controlled trial was conducted in 20 primary care practices in New York and Pennsylvania. 1,226 randomly sampled patients 60-75 years of age were screened for depression and were classified as having major depression (396), minor depression (203), or no depression (627). The practices were randomly assigned to usual care, or a depression care management intervention, which involved a depression care manager who worked with the primary care provider to recommend treatment for depression according to standard guidelines. Patients were followed for two years, and approximately 3 years after the study, death certificates were reviewed to see whether the depression intervention had any effect on mortality.

At follow-up, 223 patients had died. Patients with depression in intervention practices were less likely to have died than those in usual care practices, and risk of death was reduced in patients with major depression, but not in patients with minor depression, or among patients without depression. The benefit seemed to be almost entirely attributable to a reduction in deaths due to cancer, and the authors note that the mechanism for the effect is unclear and warrants further investigation.