Treating depression may prolong survival in elderly
Previous research has shown that depression is associated with an increased risk of mortality in older adults; and now new research indicates that this risk can be reduced through primary care-based depression intervention.
Dr. Joseph J. Gallo, from the University of Pennsylvania in Philadelphia, and colleagues assessed the 5-year risk of death in 1,226 subjects, 60 years of age or older, who entered into a general practice-based clinical trial. The 20 participating primary care practices provided usual care only or usual care plus a depression “intervention,” which involved assessment by a depression care manager.
Overall, 396 patients were diagnosed with major depression and 203 met the clinical definition for significant minor depression, according to the report in the Annals of Internal Medicine.
During an average follow-up period of 52.8 months, 223 patients died. Subjects in the depression intervention group were 33 percent less likely to die than those in the usual care group.
Further analysis showed that the benefit of the intervention was confined to patients with major depression, in whom it cut the risk of death by 45 percent, the researchers report. Patients with minor depression experienced no significant drop in mortality.
In looking at the reasons for the survival benefit, Gallo and colleagues found that the depression intervention primarily worked by reducing cancer mortality and had relatively little effect on the risk of death from other causes.
“The mechanism for an effect on deaths due to cancer is unclear,” the team notes. Nonetheless, “our study underscores the public health effect that could accrue by providing resources to help primary care clinicians better manage psychological distress and psychiatric disturbances,” the authors conclude.
“If we are to prepare for the increasing need for mental health services among older persons and to ease the burden of disability associated with depression, we must engage primary care practices as partners in developing services that interrupt the pathway from depression to death.”
Annals of Internal Medicine May 15, 2007.
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