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Prognostic factors, course, and outcome of depression among older primary care patients: the PROSPECT study
- Authors:
- BOGNER Hillary R., et al
- Journal article citation:
- Aging and Mental Health, 16(4), May 2012, pp.452-461.
- Publisher:
- Taylor and Francis
Major depression describes a clinically diverse set of people; while some patients may respond quickly to treatment, others may have a slower road to recovery. The aim of this study was to examine whether there are patterns of evolving depression symptoms among older primary care patients that are related to prognostic factors and long-term clinical outcomes. The study used data from the PROSPECT study, a multi-site, collaborative study of depression treatment in primary care settings for elderly patients. Primary care practices were randomly assigned to usual care or to an intervention consisting of a depression care manager offering algorithm-based depression care. For this study, 599 adults aged 60 years and older meeting criteria for major depression or clinically significant minor depression were randomly selected. Analysis revealed 3 patterns of change in depression symptoms over 12 months: high persistent course (19.1%); high declining course (14.4%); and low declining course (66.5%). Being in the intervention condition was more likely to be associated with a course of high and declining depression symptoms than high and persistent depression symptoms. Patients with a course of high and persistent depression symptoms were much more likely to have a diagnosis of major depression at 24 months compared with patients with a course of low and declining depression symptoms.
The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study
- Authors:
- BOGNER Hillary R., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.922-927.
- Publisher:
- Wiley
The aim was to describe the influence of domains of cognition on remission and response of depression in an intervention trial among older primary care patients. Twenty primary care practices were randomly assigned to Usual Care or to an Intervention consisting of a depression care manager offering algorithm-based care for depression. In all, 599 adults 60 years and older with a depression diagnosis were included in these analyses. Depression severity and remission of depression were assessed by the 24-item Hamilton Depression Rating Scale. The Mini-Mental State Examination (MMSE) was our global measure of cognitive function. Verbal memory was assessed with the memory subscale of the Dementia Rating Scale. Attention was measured with the digit span from the Weschler Adult Intelligence Test. Response inhibition, one of the executive functions, was assessed with the Stroop Color-Word test. The intervention was associated with improved remission and response rates regardless of cognitive impairment. Response inhibition as measured by the Stroop Color-Word test appeared to significantly modify the intervention versus usual care difference in remission and response at 4 months. Patients in the poorest performance quartile at baseline on the Stroop Color-Word test in the Intervention Condition were more likely to achieve remission of depression at 4 months than comparable patients in Usual Care [odds ratio (OR) = 17.76, 95% Confidence Interval (CI), 3.06, 103.1]. Depressed older adults in primary care with executive dysfunction have low remission and response rates when receiving usual care but benefit from depression care management.