Key result
Primary care management modestly lowers late-life depression scores at 6 months vs usual care.
Why the study?
Primary care management of late-life depression may be in need of improvement to address associated chronic illness, disability, and poor prognosis.
Does an intervention programme for depression improve MADRS scores in primary care patients aged ≥55 years compared to usual care?
RCT (n=145)
Single-blind
Cluster randomization
Yes
Does an intervention programme for depression improve MADRS scores in primary care patients aged ≥55 years compared to usual care?
A primary care intervention program for late-life depression improved depressive symptoms at 6 months compared to usual care, though the benefit was not sustained at 12 months.
Answers are grounded in this paper and cite their sources.
Supports short-term primary care programs for late-life depression; confirms 6-month benefit but leaves durability open.
BACKGROUND: Late-life depression is associated with chronic illness, disability, and a poor prognosis. Primary care management may be in need of improvement. AIM: To compare the effects of an intervention programme that aims to improve the identification, diagnosis, and treatment of depression in patients aged > or =55 years with the effects of usual care. DESIGN OF STUDY: Cluster randomised controlled trial. SETTING: General practices in the Netherlands. METHOD: Trained GPs performed the intervention and their practice assistants conducted the screenings. Patients were screened with the 15-item Geriatric Depression Scale (GDS-15) and given a consultation with the GP who diagnosed depression with the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Antidepressant treatment was proposed. Primary outcomes were measured with the Montgomery Asberg Depression Rating Scale (MADRS). Trained independent research assistants performed independent evaluations in both arms. RESULTS: Eighteen practices (23 GPs) were allocated to the intervention and 16 practices (20 GPs) to usual care. From June 2000 to September 2002, 3937 patients were screened; 579 patients had a positive score on the GDS-15, 178 had major depression, of whom 145 participated in the trial. MADRS scores for the intervention group dropped from 21.66 at baseline to 9.23 at 6 months, and the usual care group from 20.94 at baseline to 11.45 at 6 months. MADRS scores decreased during the year in both arms. For the intervention group, these scores increased between 6 and 12 months. CONCLUSION: The programme resulted in lower MADRS scores in the intervention group than in the usual care group, but only at the end of the intervention, at 6 months after baseline.
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Marwijk et al. (2008) conducted an RCT in Major depression (n=145). Disease management programme (education, drug therapy, supportive counselling) vs. Usual care was evaluated on Montgomery Åsberg Depression Rating Scale (MÅDRS) score at 6 months (δ = 0.28, p=<0.05). A primary care disease management programme for late-life depression resulted in significantly lower depressive symptom scores at 6 months compared to usual care (effect size δ = 0.28).
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