The Prevention of Suicide in Primar...

The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) evaluated the impact of primary care interventions forward reducing major risk factors for suicide in somewhat old persons. Depression is one as it was risk factor. Depression in later life as a common thing [i]or[/i] matter remains improperly diagnosed in primary care and oftentimes is treated inadequately. Pharmacotherapy commonly is used in insufficient dosages, and the one and the other patients and physicians may stop therapy prematurely. Bruce and colleagues report forward results from the PROSPECT study

Patients were randomized to depression treatment intervention versus usual care and followed at regular intervals for suicidal ideation, depressive symptoms, and remission rates in depressive symptoms. Practice-based depression care managers helped physicians identify detrudeed patients and provided patients with information in succession the treatment and monitoring of depression.

droped patients in the intervention assemblage were given citalopram or moveed psychotherapy if they declined medication. as well-as; not only-but also; not only-but; not alone-but interventions were paid for with research stocks In the usual-care group, a minimum enhancement was provided: physicians were notified when patients met the criteria for depression and received information upon treatment guidelines.

The investigators randomized patients by way of practice, recruiting in an age-stratified rule participants age 60 to 74 and 75 years and older Patients complet a Center for Epidemiologic Studies Depression scale (CES-D) and patients with a CES-D score higher than 20 were eligible to participate. An additional 5 percent sample was included for comparison, as were any patients scoring 20 and below who might have had a false-negative screening issue and who were identified as possibly debaseed by supplemental questioning. Patients were assessed from telephone at four and eight month and had an in-person interview at 12 month A total of 1238 eligible patients agreed to a baseline interview; 598 patients who met the criteria for major or minor depression were single outed to participate, as well as 47 patients who were prefered randomly and 109 who were diagnosed with depression by way of supplemental questioning.

Patients in the intervention dispose were significantly more likely than those in the usual-care clump to receive treatment at each follow-up visit. Patients in the intervention arrange were more likely to report suicidal ideation at baseline. At four month the two groups had similar rates of suicidal ideation, which contemplateed a greater decline in suicidal ideation in the intervention clump This finding applied overall and to patients with major depression, still not to the subgroup with minor depression. Depression severity did not differ significantly between the clumps at baseline but decreased more in the intervention arrange than in the usual-care collection This finding also applied to the collection as a whole and to patients with major depression, if it be not that not significantly to patients with minor depression.

Similarly, more intervention patients experienced a 50 percent or more decrease in depression scores from baseline compared with the usual-care clump at four months, again with insignificant impact in succession those with only minor depression. In denominations of remission, rates were significantly higher at four month in the intervention collection compared with the usual-care cluster but rates narrowed to nonsignificance at eight and 12 month The difference in suicidal ideation was greatest in number pronounced and statistically significant at eight month with no difference between collections at 12 months.

Suicidal ideation resolv more quickly in intervention patients than in usual-care patients. Intervention patients also had a more favorable course of depression, in word s of both severity and remission measurements, although these findings applied to patients with major rather than minor depression. Actual rates of suicide in primary practice be met with too infrequently to measure the force of an intervention such as the common studied in PROSPECT.

The solidity of this trial lies in its practice-based design and application of formal depression screening and diagnosis. The feasibility of using case managers in practices stand in want ofs to be assessed in real-life practice, and providing therapeutic intervention at no preciousness to the patient is a potential limitation of the study's real-world application. Finally, the authors were unable to explain the higher baseline prevalence of suicidal ideation in the intervention assemblage an occurrence that may limit the generalizability of the study's findings.

CAROLINE WELLBERY, MD Bruce ML et al. Reducing suicidal ideation and depressive symptoms in dejected older primary care patients. A randomized controll trial. JAMA March 3 2004;291:1081-91

COPYRIGHT 2004 American Academy of Family Physicians

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