Depression in Late Life and Causes of Death

描述（由申请人提供）：本研究的总体目标是评估老年人抑郁综合征的死亡率与总体死亡率以及与特定原因（特别是心血管疾病）死亡的关系，同时考虑基线和随时间变化的心血管风险因素以及其他潜在影响的个人和临床特征。我们将比较参加干预试验的老年人的代表性样本的死亡率，该干预试验旨在增加接受适当抑郁治疗（如抗抑郁药物和心理治疗）的老年人数量。研究样本中包含了参与干预试验的患有重度和轻度抑郁症的老年初级保健患者（n = 719），这使得研究治疗对抑郁症相关死亡风险的影响成为可能。本研究的具体目的是：（1）估计3年随访间隔后，与无显著抑郁症的患者相比，患有重度抑郁症和临床显著轻度抑郁症的老年初级保健患者的全因死亡率的相对风险，考虑潜在影响的个人和临床特征;（2）评估不同强度的抑郁症治疗是否与3年随访间隔后不同的全因死亡率相关。为了实现这些目标，我们将利用前景（“预防初级保健老年人自杀：合作试验”）中长达2年的筛查、临床评估、治疗和随访评估。前景是一项由NIMH资助的多中心协作干预研究，在初级保健实践中被随机分为两种治疗条件之一：（1）常规治疗（n = 597例患者）;（2）指南管理干预（n = 620例患者）。总共有1，217名患者，包括所有抑郁症筛查阳性的患者和筛查阴性的随机样本患者，参加了为期2年的纵向研究，并对DSM-IV重度抑郁症，轻度抑郁症和心境恶劣进行了临床评估。在前景中，719名患者符合抑郁症治疗标准。对所有1，217名患者进行了抑郁症治疗的充分性评估，无论诊断如何。我们的提案寻求支持，以确定参与者的后续生命状态（使用国家死亡指数），对于已经死亡的人，使用NDI Plus和初级保健医疗记录的数据确定主要和潜在的死亡原因。我们从这次随访中学到的知识将有助于设计专门针对降低老年抑郁症患者死亡率的干预措施，这些抑郁症通常与糖尿病和高血压等并发疾病有关。

DESCRIPTION (provided by applicant): The overarching goal of this study is to assess mortality of depressive syndromes in older adults in relation to overall death rates as well as in relation to deaths from specific causes, especially cardiovascular disease, while accounting for baseline and time-varying cardiovascular risk factors and other potentially influential personal and clinical characteristics. We will compare death rates among a representative sample of older persons who participated in an intervention trial designed to increase the number of older adults who receive appropriate depression treatment, such as antidepressant medications and psychotherapy. The study sample is enriched with older primary care patients with major and minor depression (n = 719) participating in an intervention trial, making it possible to study the impact of treatment on mortality risk associated with depression. Specific aims of this study are: (1) to estimate the relative risk of all-cause mortality among older primary care patients with major depression and clinically significant minor depression compared to patients without significant depression after a 3-year follow-up interval, accounting for potentially influential personal and clinical characteristics; and, (2) to assess whether varying intensity of depression treatment is associated with different all-cause mortality after a 3-year follow-up interval. To accomplish these aims, we will capitalize on screening, clinical assessment, treatment, and follow-up assessments which have occurred for up to 2 years in PROSPECT (the "Prevention of Suicide in Primary Care Elderly: Collaborative Trial"). PROSPECT is a collaborative multi-site intervention study funded by the NIMH in primary care practices have been randomized into one of two treatment conditions: (1) treatment as usual (n = 597 patients); and (2) a guideline management intervention (n = 620 patients). In all, 1,217 patients, including all patients who screened positive for depression and a random sample of patients who screened negative, have been enrolled in the 2-year longitudinal study and clinically evaluated for DSM-IV major depression, minor depression, and dysthymia. In PROSPECT, 719 patients met criteria for depression treatment. The adequacy of depression treatment is assessed for all 1,217 patients regardless of diagnosis. Our proposal seeks support for identifying the follow-up vital status of the participants (using the National Death Index) and, for the persons who have died, determining primary and underlying causes of death using data from NDI Plus and primary care medical records. What we learn from this follow-up will help design interventions that are specifically targeted to decrease mortality among older adults with depression that is frequently associated with concurrent medical conditions such as diabetes mellitus and hypertension.