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Regular Article |
Received February 10, 2005; revised June 20, 2005; accepted June 21, 2005. From the Dept. of Family Practice and Community Medicine, Univ. of Pennsylvania, Philadelphia, PA (HRB), the Center for Clinical Epidemiology and Biostatistics, Univ. of Pennsylvania (MSC, TTH), the Dept. of Psychiatry, Weill Medical College of Cornell University (MLB, GSA), and the Dept. of Psychiatry, Univ. of Pittsburgh School of Medicine (CFR, BM). Send correspondence and reprint requests to Hillary R. Bogner, M.D., M.S.C.E., Assistant Professor, Dept. of Family Practice and Community Medicine, Univ. of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA 19104. e-mail: bogner{at}mail.med.upenn.edu
© 2005 American Association for Geriatric Psychiatry
The PROSPECT Group
Objective: The authors described the influence of specific medical conditions on clinical remission and response of major depression (MDD) in a clinical trial evaluating a care-management intervention among older primary-care patients. Methods: Adults age 60 years and older were randomly selected and screened for depression. Participants were randomly assigned to Usual Care or to an Intervention with a depression care-manager offering algorithm-based care for MDD. In all, 324 adults meeting criteria for MDD were included in these analyses. Remission and response was defined by a score on the Hamilton Rating Scale for Depression <10 and by a decrease from baseline of 
50%, respectively. Medical comorbidity was ascertained through self-report. Cognitive impairment was defined by a score <24 on the Mini-Mental State Exam (MMSE). Results: In Usual Care, rates of remission were faster in persons who reported atrial fibrillation (AF) than in persons who did not report AF and slower in persons who reported chronic pulmonary disease than in persons who did not report chronic pulmonary disease; rates of response were less stable in persons with MMSE <24 than in those with MMSE 24. In the Intervention condition, none of the specific chronic medical conditions were significantly associated with outcomes for MDD. Conclusions: Because disease-specific findings were observed in persons who received Usual Care but not in persons who received more intensive treatment in the Intervention condition, our results suggest that the association of medical comorbidity and treatment outcomes for MDD may be determined by the intensity of treatment for depression.
Key Words: Depression • Medical Comorbidity • Primary Care
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