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document
The effect of recent bereavement on outcomes in a primary care depression intervention study . OBJECTIVES Although bereavement and depression are both common in older primary care patients , the effect of bereavement on depression intervention outcomes is unknown . We examined whether standard interventions for depression in primary care were as effective for bereaved as for non-bereaved depressed patients . DESIGN Randomized controlled trial . SETTING Twenty community-based primary care practices in New York City , greater Philadelphia , and Pittsburgh . Randomization to either intervention or usual care occurred by practice . PARTICIPANTS Patients aged 60 years or older who met criteria for major depression or clinically significant minor depression ( N = 599 ) . Patients who did not complete the bereavement measure or who were missing 4-month data were excluded ( final N = 417 ) . INTERVENTION Study-trained depression care managers offered guideline-concordant recommendations to primary care physicians at intervention sites and assisted patients with treatment adherence . Patients who did not wish to take antidepressants could receive interpersonal psychotherapy . MEASUREMENTS Bereavement was captured using the Louisville Older Persons Events Schedule . Depression severity was assessed using the 24-item Hamilton Depression Rating Scale ( HDRS ) . Outcomes at 4 months were remission ( HDRS ≤7 ) and response ( HDRS reduction ≥50 % from baseline ) . RESULTS Logistic regressions indicated that , for non-bereaved participants , response and remission were higher in intervention than usual care . However , recently bereaved older adults were less likely to achieve response or remission at 4 months if treated in the intervention condition . CONCLUSIONS Standard depression care management appears to be ineffective among recently bereaved older primary care patients . Greater attention should be paid in primary care to emotional distress in the context of bereavement .
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Intervention_Educational
standard interventions
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Intervention_Educational
intervention
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Intervention_Educational
usual care occurred by practice
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Outcome_Mental
primary care depression
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Outcome_Mental
depression
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Outcome_Mental
Louisville Older Persons Events Schedule
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Outcome_Mental
Depression severity
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Participant_Age
aged 60 years or older
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Participant_Condition
major depression
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Participant_Condition
clinically significant minor depression
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Participant_Sample-size
N = 599
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Participant_Condition
Patients who did not wish to take antidepressants could receive interpersonal psychotherapy