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, Lautenschlager, Nicola T., Stocks, Nigel, Alfonso, Helman and Pfaff, Jon J. (2012) A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Annals of Family Medicine, 10 4: 347-356. doi:10.1370/afm.1368

Author Almeida, Osvaldo P.
Pirkis, Jane
Kerse, Ngaire
Sim, Moira
Flicker, Leon
Snowdon, John
Draper, Brian
Byrne, Gerard
Goldney, Robert
Lautenschlager, Nicola T.
Stocks, Nigel
Alfonso, Helman
Pfaff, Jon J.
Title A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients
Journal name Annals of Family Medicine   Check publisher's open access policy
ISSN 1544-1709
Publication date 2012-07
Sub-type Article (original research)
DOI 10.1370/afm.1368
Open Access Status DOI
Volume 10
Issue 4
Start page 347
End page 356
Total pages 10
Place of publication Leawood, TX, United States
Publisher Annals of Family Medicine
Collection year 2013
Language eng
Formatted abstract
PURPOSE: We wanted to determine whether an educational intervention targeting general practitioners reduces the 2-year prevalence of depression and self-harm behavior among their older patients.

METHODS: Our study was a cluster randomized controlled trial conducted between July 2005 and June 2008. We recruited 373 Australian general practitioners and 21,762 of their patients aged 60 years or older. The intervention consisted of a practice audit with personalized automated audit feedback, printed educational material, and 6 monthly educational newsletters delivered over a period of 2 years. Control physicians completed a practice audit but did not receive individualized feedback. They also received 6 monthly newsletters describing the progress of the study, but they were not offered access to the educational material about screening, diagnosis and management of depression, and suicide behavior in later life. The primary outcome was a composite measure of clinically significant depression (Patient Health Questionnaire score ≥10) or self-harm behavior (suicide thoughts or attempt during the previous 12 months). Information about the outcomes of interest was collected at the baseline assessment and again after 12 and 24 months. We used logistic regression models to estimate the effect of the intervention in a complete case analysis and intention-to-treat analysis by imputed chain equations (primary analysis).

RESULTS: Older adults treated by general practitioners assigned to the intervention experienced a 10% (95% CI, 3%-17%) reduction in the odds of depression or self-harm behavior during follow-up compared with older adults treated by control physicians. Post hoc analyses showed that the relative effect of the intervention on depression was not significant (OR = 0.93; 95% CI, 0.83-1.03), but its impact on self-harm behavior over 24 months was (OR = 0.80; 95% CI, 0.68-0.94). The beneficial effect of the intervention was primarily due to the relative reduction of self-harm behavior among older adults who did not report symptoms at baseline. The intervention had no obvious effect in reducing the 24-month prevalence of depression or self-harm behavior in older adults who had symptoms at baseline.

CONCLUSIONS: Practice audit and targeted education of general practitioners reduced the 2-year prevalence of depression and self-harm behavior by 10% compared with control physicians. The intervention had no effect on recovery from depression or self-harm behavior, but it prevented the onset of new cases of self-harm behavior during follow-up. Replication of these results is required before we can confidently recommend the roll-out of such a program into normal clinical practice.
Keyword Depression
Randomized trial
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
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