The Effect of a Primary Care Practice–Based Depression Intervention on Mortality in Older Adults

Gallo, Joseph J.; Bogner, Hillary R.; Morales, Knashawn H.; Post, Edward P.; Lin, Julia; Bruce, Martha L.

doi:10.7326/0003-4819-146-10-200705150-00002

Cited by 147 publications

(51 citation statements)

References 52 publications

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“…30 A randomized clinical trial among older adults recently showed that improving depression care was associated with lower mortality. 31 Our study identifi ed potentially modifi able characteristics (eg, severity of coexisting medical disorders, unhealthy lifestyles, and glycemic control) that may be particularly important in cardiovascular-related mortality among persons with diabetes., Controlling for these factors, however, did not fully explain the association between major depression and all-cause mortality. The association of depression with a wide spectrum of mortality causes calls for reexamination of the causal mechanisms underlying the link between depression and excess mortality.…”

Section: Discussionmentioning

confidence: 99%

Depression and Increased Mortality in Diabetes: Unexpected Causes of Death

Lin¹,

Heckbert²,

Rutter³

et al. 2009

The Annals of Family Medicine

211

153

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PURPOSE Recent evidence suggests that depression is linked to increased mortality among patients with diabetes. This study examines the association of depression with all-cause and cause-specifi c mortality in diabetes. METHODSWe conducted a prospective cohort study of primary care patients with type 2 diabetes at Group Health Cooperative in Washington state. We used the Patient Health Questionnaire (PHQ-9) to assess depression at baseline and reviewed medical records supplemented by the Washington state mortality registry to ascertain the causes of death.RESULTS Among a cohort of 4,184 patients, 581 patients died during the follow-up period. Deaths occurred among 428 (12.9%) patients with no depression, among 88 (17.8%) patients with major depression, and among 65 (18.2%) patients with minor depression. Causes of death were grouped as cardiovascular disease, 42.7%; cancer, 26.9%; and deaths that were not due to cardiovascular disease or cancer, 30.5%. Infections, dementia, renal failure, and chronic obstructive pulmonary disease were the most frequent causes in the latter group. Adjusting for demographic characteristics, baseline major depression (relative to no depression) was signifi cantly associated with all-cause mortality (hazard ratio [HR] = 2.26, 95% confi dence interval [CI], 1.79-2.85), with cardiovascular mortality (HR = 2.00; 95% CI, 1.37-2.94), and with noncardiovascular, noncancer mortality (HR = 3.35; 95% CI, 2.30-4.89). After additional adjustment for baseline clinical characteristics and health habits, major depression was signifi cantly associated only with all-cause mortality (HR = 1.52; 95% CI, 1.19-1.95) and with death not caused by cancer or atherosclerotic cardiovascular disease (HR = 2.15; 95% CI, 1. 43-3.24). Minor depression showed similar but nonsignifi cant associations. CONCLUSIONSPatients with diabetes and coexisting depression face substantially elevated mortality risks beyond cardiovascular deaths. Ann Fam Med 2009:7:414-421. doi:10.1370. INTRODUCTIONE pidemiologic studies conducted in both community and medical settings fi nd that people with diabetes are more likely than others to experience depression.1 Depression affects about 20% to 25% of patients with diabetes, nearly twice as many as in the general medical population.2,3 Recent evidence suggests that patients with diabetes and coexisting depression have higher all-cause mortality relative to diabetes patients with no depression. [4][5][6][7][8] Prior studies, however, have not examined how depression infl uences cause-specifi c mortality among patients with diabetes.From incidence to complications and mortality, depression is linked to adverse health effects of diabetes. Depression-diabetes comorbidity is characterized by younger age of diabetes onset; poor management of diet, exercise, and medications; less favorable glycemic control; and higher risk of complications.9-11 End-organ damage resulting from macrovascular and microvascular complications are believed to be common causes of death among persons with diab...

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Section: Discussionmentioning

confidence: 99%

Depression and Increased Mortality in Diabetes: Unexpected Causes of Death

Lin¹,

Heckbert²,

Rutter³

et al. 2009

The Annals of Family Medicine

211

153

View full text Add to dashboard Cite

show abstract

“…They found a decrease in 5-yr mortality rates in the group randomized to the depression intervention. 89 A connection between depression and mortality in ESRD patients has been difficult to demonstrate. Some studies 90 -93 and our own work 94 initially indicated that depression was associated with mortality in this patient population.…”

Section: Depression and Mortalitymentioning

confidence: 99%

Psychosocial Aspects of Chronic Disease

Cukor¹,

Cohen²,

Peterson³

et al. 2007

Journal of the American Society of Nephrology

340

274

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“…12 Furthermore, morbidity and mortality may diminish with effective treatment of depression. 13,14 There is convincing evidence that many cases of depression go unrecognised in the general population and in primary care. [15][16][17] Reasons for under-recognition include a low rate of mood problems as the presenting complaint, infrequent specific enquiry from clinicians, and uncertainty about diagnostic criteria.…”

Section: Introductionmentioning

confidence: 99%