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Intervention lowered odds of depression and self-harm in older adults

The targeted education of general practitioners helped reduce the prevalence of depression and self-harm in older adults, according to study results.

“It is possible to decrease the prevalence of depression and suicide ideation amongst older adults living in the community by providing family physicians systematic feedback about their practice and relevant information about the assessment and management of depression and suicide behavior,” study researcher Osvaldo P. Almeida, MD, PhD, of the School of Psychiatry and Clinical Neurosciences at the University of Western Australia, told Healio.com.

While the routine use of screening instruments or case-finding procedures has increased the recognition of depression by 27%, these strategies have had no effect on treatment outcome, according Almeida and his research team.

The researchers recruited 373 Australian general practitioners and 21,762 of their patients between July, 2005 and June, 2008.

A total of 188 general practitioners (n=11,402 patients) were randomly assigned to intervention education, referred to as the Depression and Early Prevention of Suicide in General Practice strategy, which included the following:

• Printed educational material about practical aspects of the assessment and management of depression and self-harm behavior in older patients.
•  Practice audit of 20 active patients with detailed personalized audit feedback that took place within the first 6 months of the study.
•  Newsletters mailed to participating physicians 6, 12, and 18 months after being randomly assigned to their study groups.

General practitioners (n=185 with 10,360 patients, collectively) assigned to the control group did not receive the printed educational material. Instead, they completed a practice audit and received the newsletters in the mail, but audit feedback and the newsletters were not personalized and were limited to general information.

Twenty consecutive patients of each general practitioner completed self-rating questionnaires during the audit process, and the Patient Health Questionnaire-9 and the Depressive Symptom Index Suicidality Subscale were used to measure depression and suicidal ideation and impulses.

Patients treated by general practitioners assigned to intervention education experienced a 10% (95% CI, 3%-17%) reduction in the odds of depression or self-harm behavior during follow up, compared with patients under the care of general practitioners in the control group. After performing post-hoc analyses, the researchers found that the relative effect of the intervention on depression was not significant (OR=0.93; 95% CI, 0.83-1.03), but it did have a positive impact on self-harm behavior over 24 months (OR=0.80; 95% CI, 0.68-0.94).

The researchers attributed the beneficial effect of the intervention primarily to the relative reduction of self-harm behavior among patients who did not report symptoms at baseline. The intervention had no effect in reducing the 2-year prevalence of depression or self-harm behavior in patients who displayed these symptoms at baseline.

The researchers wrote that the effect of the intervention was modest, and that “because both groups of physicians participated in audit and feedback, which are activities that can change professional practice, we cannot dismiss a possible intervention effect in control physicians.” They added that replication of the results are needed before they can confidently recommend the implementation of such a program in routine clinical practice.

Disclosure: The researchers report no relevant financial disclosures.