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Care Managers Help Depressed Elderly Reduce Suicidal Thoughts
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Press Release
March 2, 2004

“Care Managers” Help Depressed Elderly Reduce Suicidal Thoughts

An intervention that includes staffing doctors' offices with depression care managers helps depressed elderly patients reduce suicidal thoughts, a study funded by NIH's National Institute of Mental Health (NIMH) has found. Martha Bruce, Ph.D., Cornell University, Charles Reynolds, III, M.D., University of Pittsburgh, and colleagues report on the outcome of the intervention in three major Eastern U.S. metropolitan areas in the March 3, 2004, Journal of the American Medical Association.

Older Americans comprise 13 percent of the population but account for 18 percent of all suicides. The major risk factor for suicide in late life is major depression.

"Since most older Americans who kill themselves have seen their doctor within a month of the event, effectively treating depression in primary care is a preventive intervention that can save lives," noted NIMH Director Thomas Insel, M.D.

Reynolds and colleagues set out to demonstrate that by educating physicians and improving treatment up to guideline standards, a social worker, nurse or masters-level psychologist can significantly improve clinical outcomes. The "depression care managers" were assigned to 10 randomly selected primary care practices in greater Philadelphia, Pittsburgh and New York City. Each practice was paired with a similar practice, which served as a control by providing its "usual care" in the study, called PROSPECT (Prevention of Suicide in Primary care Elderly: Collaborative Trial).

In initial screenings over two years, about 12 percent of the primary care patients tested positive for depression. From these, 598, mostly females and two-thirds with major depression were recruited into the study.

The care managers applied structured treatment guidelines: First, they offered patients a serotonin selective reuptake inhibitor (SSRI) or another antidepressant if clinically warranted. If a patient didn't want medication treatment, the doctor could recommend Interpersonal Psychotherapy (IPT) from the care manager, who was supervised weekly by a psychiatrist investigator. Occasionally, patients received combination treatment. The care managers actively followed up the patients, monitoring their symptoms, drug side effects and treatment adherence.

Suicidal thinking resolved more quickly in patients who received the intervention. Also, intervention patients had a more favorable course of depression, as measured by severity of symptoms, rate of treatment response, and remissions. For example, at 8 months, about 70 percent of intervention patients initially plagued by suicidal thoughts were free of them, compared to about 44 percent of "usual care" patients. Although the intervention didn't lift depression symptoms in patients with minor depression any more than usual care, it did significantly decrease suicidal thoughts in those who had them. Suicide itself occurs too infrequently in primary care for the study to have measured any impact on actual suicide rates, note the researchers.

"Without such structured, formal screening and diagnostic procedures, patients are less likely to volunteer information, accept a diagnosis of depression, or initiate treatment," explained Reynolds. "Our finding in an elderly population adds to evidence from other studies that structured interventions can improve the quality of depression care in primary care."

The results of PROSPECT indicate that quality treatment of depression in primary care can be a prevention strategy to reduce the risk for suicide in late life.

Other researchers participating in the PROSPECT study are: Herbert Schulberg, Ph.D., Gail McAvay, Ph.D., George Alexopoulos, M.D., Cornell University; Thomas Have, Ph.D., Ira Katz, M.D., Ph.D., Gregory Brown, Ph.D., University of Pennsylvania; Benoit Mulsant, M.D., University of Pittsburgh; Jane Pearson, Ph.D., NIMH.

###

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

Press Contact(s)

Jules Asher
NIMH Press Office
301-443-4536
NIMHpress@nih.gov

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This page last reviewed: November 7, 2007

Internet Citation:   http://www.nimh.nih.gov/science-news/2004/care-managers-help-depressed-elderly-reduce-suicidal-thoughts.shtml

 

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Posted by: Sanjeev11  on  11/12/2016
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Posted by: Crismartin2145  on  07/19/2016
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Posted by: Thanh145  on  05/09/2016
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Actually, you will come to realize that most of the celebrities and fashion lovers and those who like to make up a unique and distinctive mark for themselves at the wedding, choose custom made plus size dresses. Instead of picking up a readymade designer that is out of fashion, custom made evening summer dresses can be stitched and made according to the latest trend. It certainly gives a peace of mind when the bride is rest assured that the wedding dress is perfectly made in accordance with her sizes and measurements and is not ill- fitting. Of course, the especially made cheap mother of the bride dresses will make her smile naturally to add glow to her face in the off the shoulder evening dresses.
Posted by: samortha  on  08/09/2011
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There is no doubt that everyone knows your wedding day is the most special and memorable day of your live and numerous brides dream of this day for years. When your expected day is approaching, you have many choices and prom dresses cheap to take. I want to take a few minutes and talk about your shoes. There is no stipulation that you can't comfortable wedding shoes. There is no doubt that the high heels shoes have always been very popular in the fashion world. However, I don't think the reason for its popularity is due to the reason that they are comfortable. Let me tell you a little secret that most brides choose to wear these high heel shoes because that's what they are used to seeing on TV shows and fashion magazines. But the actual fact is that if you are dreaming to wear comfortable cheap wedding dresses, you shouldn't even try high heels. Please don't feel embarrassed on hearing this news. There is actually a better solution for comfortable wedding dresses 2011, and there is no reason you shouldn't know about it that is the flat wedding shoes. I know some of you will consider such kind of the footwear is not fancy and trendy enough. However, I have to tell you that you are totally wrong.
Posted by: samortha  on  08/09/2011
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