Physician-targeted intervention could reduce depression in elderly

By Sarah Guy

Older patients whose physicians take part in a practice audit and education-based intervention have reduced odds of depression and self-harm at 24 months - significantly so in the case of self-harm, show results of an Australian trial.

The effect of the intervention was primarily due to the relative reduction of self-harm behavior among patients who were symptomless at baseline, say the researchers.

While the effects were modest - a combined 3-17% reduction in odds of displaying either depression or self-harm behaviors - the team explains that previous evidence indicates "interventions incorporating clinician education, case management, and integration between primary and secondary care have a greater chance of being effective than interventions limited to education."

As reported in the Annals of Family Medicine, the current study involved a total of 21,762 adult patients aged a mean 71.8 years, under the care of 373 general practitioners, of whom 188 (n=11,402 patients) were randomly assigned to the intervention, and 185 (n=10,360 patients) to a control group.

The intervention involved distribution of printed material concerning practical aspects of assessment and management of depression and self-harm in later life, a practice audit of 20 active patients with detailed feedback, and newsletters outlining the progress of the study relative to physicians' individual practices.

Physicians in the control group took part in the practice audit, but only received pooled feedback data, and received no printed educational material.

After adjustment for potential confounders including patients' baseline depression and self-harm scores (measured on the Patient Health Questionnaire and the Depressive Symptom Index Suicidality Subscale, respectively), those under the care of physicians in the intervention group were 10% less likely to experience either outcome after 12 and 24 months than controls.

The effect of the intervention on depression was not significant (odds ratio=0.93), report Osvaldo Almeida, from the University of Western Australia, Perth, and colleagues. However, the effect of the intervention on patients' suicide ideation or attempts over 24 months was significant, with a reduction of 20% compared with the control group.

Furthermore, self-harm behavior was a significant 20% less in intervention versus control group patients, add the authors.

However, they observed no difference in rates of depression or self-harm in patients who reported these behaviors on entering the trial.

"Replication of these results is required before we can confidently recommend the roll out of such a program into normal clinical practice," conclude Almeida et al.

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