LDER AMERICANS COMprise about 13% of the US population, yet account for 18% of all suicide deaths. 1 Among adults who attempt suicide, the elderly are most likely to die as a result. 2 Recent national reports emphasize the public health need for intervention trials to reduce the risk for suicide in late life. 3,4 This article presents initial outcomes from the multisite, randomized trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). PROSPECT tested the impact of a primary carebased intervention on reducing major risk factors for suicide in late life. Primary care practices were important to study because the majority of older adults who die by suicide have seen their physician within months of their death. 5,6 PROSPECT approached suicide risk reduction from a public health perspective by targeting factors that are strongly related to suicide risk, common in primary care, and malleable. 7 Depression is the principal risk factor for suicide Author Affiliations and Financial Disclosures are listed at the end of this article.

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ORONARY ARTERY BYPASS graft (CABG) surgery is one of the most common and costly medical procedures performed in the United States. 1 Its main indications are the relief of angina and improvement in quality of life. 2 Yet as many as half of post-CABG patients report depressive symptoms in the perioperative period, 3 are more likely to experience a decreased healthrelated quality of life (HRQL) and functional status, 4 continued chest pains, 5,6 and inreased rates of rehospitalization and death following CABG surgery independent of cardiac status, medical comorbidity, or the extent of surgery. [7][8][9][10][11] Although the mechanism whereby depression affects post-CABG outcomes remains unknown, 12 widely generalizable strategies to detect and effectively treat post-CABG depression are of great interest. Several treatment trials for depression have been conducted in cardiac populations, but most achieved less than anticipated benefits with regard to reducing mood symptoms [13][14][15][16][17][18][19] or cardiovascular morbidity. [13][14][15][16]19,20 Moreover, none used the proven effective collabo-rative care approach 21 recently recommended by a National Institutes of Health expert consensus panel. 22 Unlike earlier interventions that used a single antidepressant, 13,15,17,18 counseling modality, 20 or antidepressant in combination with counseling for treating cardiacpatientswithdepression, 14,19 collabo-rative care emphasizes a flexible realworld treatment package that involves active follow-up by a nonphysician care manager who adheres to evidence-based Author Affiliations are listed at the end of this article.

Standardized treatments for depression lead to better outcomes than usual care but also lead to higher costs. However, the estimates of the cost per quality-of-life year gained for standardized pharmacotherapy are comparable with those found for other treatments provided in routine practice.