| Titre : | Reducing suicidal ideation and depressive symptoms in depressed older Primary Care patients : A Randomized controlled trial. (2004) |
| Auteurs : | Martha-L BRUCE ; George-S ALEXOPOULOS ; Gregory-K BROWN ; Ira-I KATZ ; Gail-J MCAVAY ; Benoit-H MULSANT ; Jane-L PEARSON ; Charles-Fiii REYNOLDS ; Herbert-C SCHULBERG ; Thomas-R TEN HAVE ; Department of Psychiatry. University of Pennsylvania. Philadelphia. USA ; Department of Psychiatry. University of Pittsburgh School of Medicine. Pittsburgh. PA. USA ; Department of Psychiatry. Weill Medical College of Cornell University. White Plains. NY. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 291, n° 9, 2004) |
| Pagination : | 1081-1091 |
| Langues: | Anglais |
| Mots-clés : | Etat dépressif ; Personne âgée ; Homme ; Soins santé primaire ; Essai préventif ; Essai thérapeutique ; Prévention santé ; Trouble humeur |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 2eR0xeIH. Diffusion soumise à autorisation]. Context : Suicide rates are highest in late life ; the majority of older adults who die by suicide have seen a primary care physician in preceding months. Depression is the strongest risk factor for late-life suicide and for suicide's precursor, suicidal ideation. Objective : To determine the effect of a primary care intervention on suicidal ideation and depression in older patients. Design and Setting : Randomized controlled trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly : Collaborative Trial) with patient recruitment from 20 primary care practices in New York City, Philadelphia, and Pittsburgh regions, May 1999 through August 2001. Participants Two-stage, age-stratified (60-74,>=75 years) depression screening of randomly sampled patients ; enrollment included patients who screened positive and a random sample of screened negative patients. This analysis included patients with a depression diagnosis (N=598). Intervention Treatment guidelines tailored for the elderly with care management compared with usual care. Main Outcome Measures : Assessment of suicidal ideation and depression severity at baseline, 4 months, 8 months, and 12 months. Results Rates of suicidal ideation declined faster (P=01) in intervention patients compared with usual care patients ; at 4 months, in the intervention group, raw rates of suicidal ideation declined 12.9% points (29.4% to 16.5%) compared with 3.0% points (20.1% to 17.1% in usual care [P=01]). Among patients reporting suicidal ideation, resolution of ideation was faster among intervention patients (P=03) ; differences peaked at 8 months (70.7% vs 43.9% resolution ; P=005). Intervention patients had a more favorable course of depression in both degree and speed of symptom reduction ; group difference peaked at 4 months. The effects on depression were not significant among patients with minor depression unless suicidal ideation was present. Conclusions : Evidence of the intervention's effectiveness in community-based primary care with a heterogeneous sample of depressed patients introduces new challenges related to its sustainability and dissemination. The intervention's effectiveness in reducing suicidal ideation, regardless of depression severity, reinforces its role as a prevention strategy to reduce risk factors for suicide in late life. |
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