Sunday, May 07, 2006

PROSPECT for Survivial

The NIMH sposored a study, called the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT).  PROSPECT ran from 1999 to 2005, and has resulted in three papers, plus one abstract.

Bruce ML, Ten Have TR, Reynolds CF 3rd, Katz II, Schulberg HC, Mulsant BH, Brown GK, McAvay GJ, Pearson JL, Alexopoulos GS. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA. 2004 Mar 3;291(9):1081-91.

Alexopoulos GS, Katz IR, Bruce ML, Heo M, Ten Have T, Raue P, Bogner HR, Schulberg HC, Mulsant BH, Reynolds CF 3rd; PROSPECT Group. Remission in depressed geriatric primary care patients: a report from the PROSPECT study. Am J Psychiatry. 2005 Apr;162(4):718-24.

Gallo JJ, Bogner HR, Morales KH, Post EP, Ten Have T, Bruce ML. Depression, cardiovascular disease, diabetes, and two-year mortality among older, primary-care patients. Am J Geriatr Psychiatry. 2005 Sep;13(9):748-55.

The abstract I mentioned was just presented at the annual meeting of the American Geriatrics Society, and is reported on Medscape News (free registration required).  None of the papers mention that they were successful in reducing the risk of suicide, although the later reports indicate that suicidal thinking was reduced.  

The interesting thing is that the patients in the intervention group tended to live longer, as reported in the AGS abstract.
"We found that depressed older adults in the intervention practices were less likely to die over a 4-year follow-up period compared to not-depressed older adults in the usual-care practices," Dr. Bogner said. She noted that her findings reached statistical significance.
The intervention was simple.  They assigned patients randomly to receive either usual care, or to receive intervention by primary care physicians who were assisted by a "masters level depression specialist."
The study method involved deploying a masters level depression specialist to collaborate with the patient's primary care physician (PCP) with the goal of improving patient adherence to medical therapy for depression. The specialist also educated both the PCP and the patient's family about the issues involved. A "depression care manager" provided general treatment recommendations for all study patients. The manager did not make specific recommendations for individual patients.
Notice that the intervention is the sort of thing that could be done easily almost anywhere, at little cost.  However, notice also that it would be difficult to find someone to pay for the intervention.