This article is more than 5 years old. Information may no longer be current.

Major depression treatment reduces risk for death among older adults with diabetes

Mental health treatment resulted in a statistically significant effect on mortality for diabetes among older patients with major depression, highlighting the need for better communication between mental health and primary care, according to data published in the Journal of the American Geriatrics Society.

“Depression and chronic medical conditions are commonly encountered in primary care settings,” Hillary R. Bogner, MD, MSCE, of the department of family medicine and community health, Perelman School of Medicine, at the University of Pennsylvania, in Philadelphia, and colleagues wrote. “ … Although some randomized trials of depression interventions have reported on mortality outcomes, most notably focused on heart disease, few studies have examined whether treating depression decreases mortality in various chronic medical conditions.”

To determine whether treating depression decreases mortality from various chronic medical conditions, the researchers conducted a long-term follow-up of the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT), a multisite, randomized and controlled study that assessed the effect of the use of care management on reducing major risk factors for suicide in later life, particularly depression. In that study, 20 primary care practices had been randomly placed into one of two groups: intervention or usual care.

The study sample included 1,226 individuals aged 60 years and older, identified through depression screening of random patients. For 2 years, a depression care manager worked with primary care physicians in intervention practices to provide an algorithm-based treatment for depression. In the follow-up, the researchers determined mortality risk based on a median follow-up of 98 months through 2008. Chronic medical conditions were self-reported.

According to the researchers, older adults with major depression and diabetes were less likely to die when in practices placed into the intervention group (HR=0.47, 95% CI=0.24-0.91). For heart disease, patients with major depression had a greater risk for death regardless of whether they received the intervention or usual care. For other medical conditions, the point estimate for mortality in patients with major depression indicated a lower risk, but did not reach statistical significance.

“The Patient Protection and Affordable Care Act, signed into law in March 2010, provides new impetus for treating medical comorbidity and depression,” Bogner and colleagues wrote. “Highlighted was the need for better communication between mental health and primary care, the inclusion of mental health management in the medical home model for diabetes and other conditions, and new models of integrated health care delivery. Integrated care is a promising development for management of complex older adults with comorbid conditions such as diabetes and depression.” – by Jason Laday