Remission in depressed geriatric primary care patients: A report from the PROSPECT study

George S. Alexopoulos, Ira R. Katz, Martha L. Bruce, Moonseong Heo, Thomas Ten Have, Patrick Raue, Hillary R. Bogner, Herbert C. Schulberg, Benoit H. Mulsant, Charles F. Reynolds

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Objective: This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists. Method: Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (≥60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months. Results: First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety. Conclusions: Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.

Original languageEnglish (US)
Pages (from-to)718-724
Number of pages7
JournalAmerican Journal of Psychiatry
Volume162
Issue number4
DOIs
StatePublished - Apr 2005
Externally publishedYes

Fingerprint

Geriatrics
Suicide
Primary Health Care
Depression
Anxiety
Mental Health
Referral and Consultation
Delivery of Health Care
Physicians
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Alexopoulos, G. S., Katz, I. R., Bruce, M. L., Heo, M., Ten Have, T., Raue, P., ... Reynolds, C. F. (2005). Remission in depressed geriatric primary care patients: A report from the PROSPECT study. American Journal of Psychiatry, 162(4), 718-724. https://doi.org/10.1176/appi.ajp.162.4.718

Remission in depressed geriatric primary care patients : A report from the PROSPECT study. / Alexopoulos, George S.; Katz, Ira R.; Bruce, Martha L.; Heo, Moonseong; Ten Have, Thomas; Raue, Patrick; Bogner, Hillary R.; Schulberg, Herbert C.; Mulsant, Benoit H.; Reynolds, Charles F.

In: American Journal of Psychiatry, Vol. 162, No. 4, 04.2005, p. 718-724.

Research output: Contribution to journalArticle

Alexopoulos, GS, Katz, IR, Bruce, ML, Heo, M, Ten Have, T, Raue, P, Bogner, HR, Schulberg, HC, Mulsant, BH & Reynolds, CF 2005, 'Remission in depressed geriatric primary care patients: A report from the PROSPECT study', American Journal of Psychiatry, vol. 162, no. 4, pp. 718-724. https://doi.org/10.1176/appi.ajp.162.4.718
Alexopoulos, George S. ; Katz, Ira R. ; Bruce, Martha L. ; Heo, Moonseong ; Ten Have, Thomas ; Raue, Patrick ; Bogner, Hillary R. ; Schulberg, Herbert C. ; Mulsant, Benoit H. ; Reynolds, Charles F. / Remission in depressed geriatric primary care patients : A report from the PROSPECT study. In: American Journal of Psychiatry. 2005 ; Vol. 162, No. 4. pp. 718-724.
@article{8cba12b053f249bfbb2fe7f2a042f66f,
title = "Remission in depressed geriatric primary care patients: A report from the PROSPECT study",
abstract = "Objective: This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists. Method: Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (≥60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months. Results: First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety. Conclusions: Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.",
author = "Alexopoulos, {George S.} and Katz, {Ira R.} and Bruce, {Martha L.} and Moonseong Heo and {Ten Have}, Thomas and Patrick Raue and Bogner, {Hillary R.} and Schulberg, {Herbert C.} and Mulsant, {Benoit H.} and Reynolds, {Charles F.}",
year = "2005",
month = "4",
doi = "10.1176/appi.ajp.162.4.718",
language = "English (US)",
volume = "162",
pages = "718--724",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "4",

}

TY - JOUR

T1 - Remission in depressed geriatric primary care patients

T2 - A report from the PROSPECT study

AU - Alexopoulos, George S.

AU - Katz, Ira R.

AU - Bruce, Martha L.

AU - Heo, Moonseong

AU - Ten Have, Thomas

AU - Raue, Patrick

AU - Bogner, Hillary R.

AU - Schulberg, Herbert C.

AU - Mulsant, Benoit H.

AU - Reynolds, Charles F.

PY - 2005/4

Y1 - 2005/4

N2 - Objective: This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists. Method: Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (≥60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months. Results: First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety. Conclusions: Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.

AB - Objective: This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists. Method: Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (≥60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months. Results: First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety. Conclusions: Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.

UR - http://www.scopus.com/inward/record.url?scp=20144387158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=20144387158&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.162.4.718

DO - 10.1176/appi.ajp.162.4.718

M3 - Article

C2 - 15800144

AN - SCOPUS:20144387158

VL - 162

SP - 718

EP - 724

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 4

ER -