A Randomized Trial to Reduce the Prevalence of Depression and Self-Harm Behavior in Older Primary Care Patients

Almeida, Osvaldo P.; Pirkis, Jane; Kerse, Ngaire; Sim, Moira; Flicker, Leon; Snowdon, John; Draper, Brian; Byrne, Gerard; Goldney, Robert D.; Lautenschlager, Nicola T.; Stocks, Nigel; Alfonso, Helman; Pfaff, Jon J.

doi:10.1370/afm.1368

Cited by 61 publications

(75 citation statements)

References 49 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such a discrepancy may be partly due to the fact that, among the severe mental disorders, major depression is the condition most commonly treated outside mental health specialist settings [31]. Consequently, depressive disorders recorded in the WADLS are most likely true cases (i.e., high specificity), although the system may lack sensitivity to identify uncomplicated depression managed successfully in the primary care sector.…”

Section: Discussionmentioning

confidence: 99%

Mortality among People with Severe Mental Disorders Who Reach Old Age: A Longitudinal Study of a Community-Representative Sample of 37892 Men

et al. 2014

View full text Add to dashboard Cite

BackgroundSevere mental illnesses are leading causes of disability worldwide. Their prevalence declines with age, possibly due to premature death. It is unclear, however, if people with severe mental disorders who reach older age still have lower life expectancy compared with their peers and if their causes of death differ.Methods and FindingsCohort study of a community-representative sample of 37892 Australian men aged 65–85 years in 1996–1998. Follow up was censored on the 31st December 2010. Lifetime prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorder was established through record linkage. A subsample of 12136 consented to a face-to-face assessment of sociodemographic, lifestyle and clinical variables. Information about causes of death was retrieved from the Australian Death Registry. The prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorders was 1.2%, 0.3%, 2.5% and 1.8%. The mortality hazard for men with a severe mental disorder was 2.3 and their life expectancy was reduced by 3 years. Mortality rates increased with age, but the gap between men with and without severe mental disorders was not attenuated by age. Cardiovascular diseases and cancer were the most frequent causes of death. The excess mortality associated with severe mental disorders could not be explained by measured sociodemographic, lifestyle or clinical variables.ConclusionsThe excess mortality associated with severe mental disorders persists in later life, and the causes of death of younger and older people with severe mental disorders are similar. Hazardous lifestyle choices, suboptimal access to health care, poor compliance with treatments, and greater severity of medical comorbidities may all contribute to this increased mortality. Unlike young adults, most older people will visit their primary care physician at least once a year, offering health professionals an opportunity to intervene in order to minimise the harms associated with severe mental disorders.

show abstract

Section: Discussionmentioning

confidence: 99%

Mortality among People with Severe Mental Disorders Who Reach Old Age: A Longitudinal Study of a Community-Representative Sample of 37892 Men

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Both suicide attempts [10] and suicidal ideation [11] are found to be associated with depression among older adults. Furthermore, a case-control study among persons older than 65 years who committed suicide found depression to be a strong risk factor for suicide [12].…”

Section: Introductionmentioning

confidence: 99%

Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality

Bendixen

Engedal

Selbæk

et al. 2018

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Objective: Anxiety symptoms are common in older adults with depression, but whether severe anxiety is associated with poorer outcomes of depression is unknown. The objective of the present study was to examine the association between severity of anxiety and severity of depression and physical illness, suicidality, and physical and cognitive functioning in older adults with depression. Methods: We included 218 older adults with diagnoses of a depressive disorder according to the ICD-10 criteria; their mean age (SD) was 75.6 (7.2), and 67.0% were women. The Geriatric Anxiety Inventory (GAI) was used to measure the severity of anxiety symptoms. The Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess the severity of depression. We obtained information on the level of functioning with the Physical Self-Maintenance Scale (PSMS) by Lawton and Brody and on cognition with the Mini-Mental State Examination (MMSE) and the Clock-Drawing Test (CDT). Physical health was determined based on information regarding falls and weight loss and an assessment of each patient’s general medical condition. The treating physician evaluated current suicidality in a comprehensive and standardized way. Results: Higher GAI scores were significantly associated with scores on the MADRS (β = 0.233, p = 0.002) and suicidality (β = 0.206, p = 0.006). Levels of physical or cognitive functioning were not associated with the GAI score. Conclusion: The severity of anxiety symptoms was associated with the severity of depression and suicidality in older adults with depressive disorders. The results could indicate a need to focus greater attention on the treatment of anxiety and suicidality in older patients with depression.

show abstract

“…We have an established record of success for recruiting participants into large community-based trials and of collaborative work with primary care physicians, such as the Health In Men Study [40] and the Depression and Early Prevention of Suicide in General Practice (DEPS-GP) project [26]. We are therefore confident that our recruitment strategy will yield the required number of participants.…”

Section: Discussionmentioning

confidence: 99%

“…Oestrogen-containing hormone therapy is recommended for women with moderate to severe vasomotor symptoms without other contra-indications [13], and preliminary evidence suggests that it may also improve mood [16]. As the origin of depression during the MT is most likely multifactorial, its optimal management and prevention should target multiple factors, which is consistent with the results of successful interventions designed to decrease the prevalence of depression and suicide ideation in later life [26]. …”

Section: Introductionmentioning

confidence: 95%

Reducing depression during the menopausal transition: study protocol for a randomised controlled trial

Almeida

Marsh

Flicker

et al. 2014

Trials

View full text Add to dashboard Cite

BackgroundThe menopausal transition (MT) is a biological inevitability for all ageing women that can be associated with changes in mood, including depressive symptoms. There is tentative evidence that women who develop depression during the MT have greater risk of subsequent depressive episodes, as well as increased health morbidity and mortality. Thus, preventing depression during the MT could enhance both current and the future health and well-being of women. This study aims to test the efficacy of a client-centred health promotion intervention to decrease the 12-month incidence of clinically significant symptoms of depression among women undergoing the MT.Methods/DesignThis randomised controlled trial will recruit 300 women undergoing the MT living in the Perth metropolitan area. They will be free of clinically significant symptoms of depression and of psychotic or bipolar disorders. Consenting participants will be stratified for the presence of subsyndromal symptoms of depression and then randomly assigned to the intervention or control group. The intervention will consist of eight telephone health promotion sessions that will provide training in problem solving and education about the MT, healthy ageing, depression and anxiety, and management of chronic health symptoms and problems. The primary outcome of interest is the onset of a major depressive episode according the DSM-IV-TR criteria during the 12-month follow-up or of clinically significant symptoms of depression, as established by a score of 15 or greater on the Patient Health Questionnaire (PHQ-9). Secondary outcomes of interest include changes in the severity of symptoms of depression and anxiety (Hospital Anxiety and Depression Scale, HADS), quality of life (Short Form Health Survey, SF-12), and lifestyle.DiscussionCurrent evidence shows that depressive symptoms and disorders are leading causes of disability worldwide, and that they are relatively common during the MT. This study will use a multifaceted health promotion intervention with the aim of preventing depression in these women. If successful, the results of this trial will have implications for the management of women undergoing the MT.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12613000724774. Date registered: 1 July 2013.

show abstract

A Randomized Trial to Reduce the Prevalence of Depression and Self-Harm Behavior in Older Primary Care Patients

Cited by 61 publications

References 49 publications

Mortality among People with Severe Mental Disorders Who Reach Old Age: A Longitudinal Study of a Community-Representative Sample of 37892 Men

Mortality among People with Severe Mental Disorders Who Reach Old Age: A Longitudinal Study of a Community-Representative Sample of 37892 Men

Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality

Reducing depression during the menopausal transition: study protocol for a randomised controlled trial

Contact Info

Product

Resources

About