Reducing Suicidal Ideation and Depression in Older Primary Care Patients: 24-Month Outcomes of the PROSPECT Study

Alexopoulos, George S.; Reynolds, Charles F.; Bruce, Martha L.; Katz, Ira R.; Raue, Patrick J.; Mulsant, Benoit H.; Oslin, David W.; Have, Thomas Ten

doi:10.1176/appi.ajp.2009.08121779

Cited by 331 publications

(280 citation statements)

References 30 publications

Supporting

Mentioning

271

Contrasting

Unclassified

Order By: Relevance

“…Comprehensive risk assessments which take into account a wide range of demographic and clinical factors (for example, employment, living circumstances, age, gender, history of self-harm or substance misuse, physical health) are an important suicide prevention measure. 2 Patients who express suicidal ideation at their last consultation but who are rated as low risk (6 patients in 18 primary care and 7 patients in secondary care in this study) may be an important group in whom to intervene.…”

Section: Clinical and Research Implicationsmentioning

confidence: 91%

“…Similar to previous studies we found that many patients who died (nearly half the sample) had in fact been rated as at low risk when they were last seen by their clinicians. 18 This 'low risk' paradox in patients who go on to die by suicide reflects the problems inherent in predicting low frequency events, but rapidly changing risk, desensitization to high risk situations (particularly in specialist care), and recall bias might also contribute. 18 In primary care, presentation with physical complaints could mask psychological symptoms and lead to a downgrading of risk.…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

See 1 more Smart Citation

Assessment and Management of Suicide Risk in Primary Care

Saini

While

Chantler

et al. 2014

Crisis

View full text Add to dashboard Cite

Background: Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aims: To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method: Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Results: Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Conclusion: Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.

show abstract

Section: Clinical and Research Implicationsmentioning

confidence: 91%

Section: Clinical and Research Implicationsmentioning

confidence: 99%

Assessment and Management of Suicide Risk in Primary Care

Saini

While

Chantler

et al. 2014

Crisis

View full text Add to dashboard Cite

show abstract

“…[12][13][14][15] These effects are stronger when collaborative care models of depression treatment are used. 16,17 pATIEnT GroUpS AT rISk Years of research on suicide show those with current psychiatric illness are the most common group dying by sui-…”

Section: Importance To Primary Carementioning

confidence: 99%

“…They show promise in not only decreasing suicidal behavior 16 but also increasing overall levels of combined treatment with pharmacotherapy and psychotherapy plus faster time to remission vs treatment as usual. 16,42 For example, the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) was more effective than treatment as usual in reducing suicide risk in patients aged 60 years or older. 16 This finding was present in urban, suburban, and rural practice sites.…”

Section: Education Vs Practice Model Changementioning

confidence: 99%

“…16,42 For example, the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) was more effective than treatment as usual in reducing suicide risk in patients aged 60 years or older. 16 This finding was present in urban, suburban, and rural practice sites. Collaborative care patients were more likely to receive treatment and had higher rates of remission of major depression at 4 (26.6% vs 15.2%), 8 (36.0% vs 22.5%), and 24 months (45.4% vs 31.5%).…”

Section: Education Vs Practice Model Changementioning

confidence: 99%

See 1 more Smart Citation

Practical Suicide-Risk Management for the Busy Primary Care Physician

McDowell

Lineberry

Bostwick

2011

Mayo Clinic Proceedings

111

View full text Add to dashboard Cite

Suicide is a public health problem and a leading cause of death. The number of people thinking seriously about suicide, making plans, and attempting suicide is surprisingly high. In total, primary care clinicians write more prescriptions for antidepressants than mental health clinicians and see patients more often in the month before their death by suicide. Treatment of depression by primary care physicians is improving, but opportunities remain in addressing suicide-related treatment variables. Collaborative care models for treating depression have the potential both to improve depression outcomes and decrease suicide risk. Alcohol use disorders and anxiety symptoms are important comorbid conditions to identify and treat. Management of suicide risk includes understanding the difference between risk factors and warning signs, developing a suicide risk assessment, and practically managing suicidal crises. Mayo Clin © 2011 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) [3][4][5] These worries are based on population-level effects of the persistent increased unemployment rate due to the severe recession. [3][4][5] Serious thoughts of suicide, plans for suicide, and suicide attempts are surprisingly common in the general population (Table 1). 6 Despite that frequency, death by suicide is still a low base-rate occurrence and impossible to predict accurately. 7,8 Although a relatively uncommon event, suicide has a lifelong and profound effect personally on the families, friends, and physicians of the person committing suicide.In this concise review, we provide a pragmatic and clinically relevant background on suicide risk management for nonpsychiatrists. We will use frequently asked questions based on our clinical experiences and review key principles of depression treatment as they relate to suicide risk management. We will update and synthesize information gained from research into concerns associated with the antidepressant black box warnings (BBWs) for suicidality and highlight their 2009 revisions. 9 We will then close by describing basic principles in identifying those at risk of suicide, assessing them, and devising practical patient management strategies. IMporTAnCE To prIMAry CArETwo practice realities have spurred interventions to improve primary care recognition and treatment of depression as a public health suicide prevention strategy. 10,11 First, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. 10 A review of studies analyzing this clinical scenario estimated 45% of those dying by suicide saw their primary care physician in the month before their death. 10 Only 20% saw a mental health professional 10 in the preceding month. Women and older patients are more likely to have sought care in the month before suicide 10 than men and younger patients. Second, generalists (internists, pediatricians, family physicians) write most antidepressant prescriptions (62%) in the United States. 11 When...

show abstract

Collaborative Depression Care Management and Disparities in Depression Treatment and Outcomes

Bao

Alexopoulos²,

Casalino³

et al. 2011

Arch Gen Psychiatry

Self Cite

View full text Add to dashboard Cite

Context Collaborative depression care management (DCM), by addressing barriers disproportionately affecting patients of racial/ethnic minority and low education, may reduce disparities in depression treatment and outcomes. Objective To examine the effect of DCM on treatment disparities by education and ethnicity among older depressed primary care patients. Design, Setting and Participants Analysis of data from a randomized controlled trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). This analysis included patients from 20 primary care practices, 60 or older, and with major depression (n=396). We conducted model-based analysis to estimate potentially differential intervention effects by education, independent of those by ethnicity (and vice versa). Intervention Algorithm-based recommendations to physicians and care management by depression care managers. Main Outcome Measures Antidepressant use, depressive symptoms and intensity of DCM over 2 years Results The PROSPECT intervention had a larger and more lasting effect among less-educated patients. At month 12, the intervention increased the rate of adequate antidepressant use by 14.2 percentage points (pps) [95% confidence interval (CI): 1.7, 26.4] among the no-college group, compared with a null effect among the college-educated (−9.2 pps [95% CI: −25.0, 2.7]); at month 24, the intervention reduced depressive symptoms by 2.6 points on the Hamilton Depression Rating Scale [95% CI: −4.6, −0.4] among no-college patients, 3.8 points [95% CI: −6.8, −0.4] more than among the college group. The intervention benefitted non-Hispanic whites more than minority patients. Intensity of DCM received by minorities was 60-70% of that by whites after the initial phase, but did not differ by education. Conclusions The PROSPECT intervention substantially reduced disparities by patient education, but failed to mitigate racial/ethnic disparities, in depression treatment and outcomes. Incorporation of culturally-tailored strategies in DCM models may be needed in order to extend their benefits to minorities.

show abstract

Reducing Suicidal Ideation and Depression in Older Primary Care Patients: 24-Month Outcomes of the PROSPECT Study

Cited by 331 publications

References 30 publications

Assessment and Management of Suicide Risk in Primary Care

Assessment and Management of Suicide Risk in Primary Care

Practical Suicide-Risk Management for the Busy Primary Care Physician

Collaborative Depression Care Management and Disparities in Depression Treatment and Outcomes

Contact Info

Product

Resources

About