Journal
AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY
Volume 18, Issue 4, Pages 341-350Publisher
ELSEVIER SCIENCE INC
DOI: 10.1097/JGP.0b013e3181c37cfe
Keywords
Suicidal ideation; wish to die; mortality; primary care; geriatrics
Categories
Funding
- National Institute of Mental Health [R01 MH065539]
- Advanced Centers for Intervention and Services Research of: Cornell University (PROSPECT Coordinating Center) [R01 MH59366, P30 MH68638]
- University of Pennsylvania [R01 MH59380, P30 MH52129]
- University of Pittsburgh [R01 MH59381, P30 MH52247]
- NIMH [R01 MH065539, R01 MH59366, P30 MH68638, R01 MH59380, P30 MH52129, R01 MH59381, P30 MH52247, K23 MH069784, K01 MH073903, K23 MH67671, K23 MH01879, K02 MH01634]
- Robert Wood Johnson Foundation
- Forest Laboratories
- John D. Hartford Foundation
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Objectives: The authors examined the impact of the wish to die on mortality over a 5-year period, stratified by baseline depressive status (i.e., major, minor, and no depression diagnosis). The authors also examined whether a depression care management intervention would minimize these relationships. Design: Longitudinal analyses of the practice-randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Setting: Twenty primary care practices from New York City, Philadelphia, and Pittsburgh. Participants: One thousand two hundred two participants were identified through two-stage, age-stratified (60-74 years; 75 years and older) depression screening of randomly sampled participants. Intervention: Practices randomized to Care Management Intervention or Usual Care conditions. Measurements: Vital status at 5 years using the National Death Index. Results: Rates of the wish to die were 29% (major depression), 11% (minor depression), and 7% (no depression). In Usual Care, the wish to die was associated with an increased risk of 5-year mortality across depressive status (adjusted hazard ratios ranging from 1.62 to 1.71). In intervention practices, this association was greater among the no depression (adjusted hazard ratio 1.64) compared with major depression group (adjusted hazard ratio 0.68). Conclusions: The wish to die was associated with mortality in the usual care of elderly primary care patients, suggesting that the wish to die has clinical significance and may be worth assessing even in patients without other evidence of depression. This association was not observed among depressed patients located in primary care practices that implemented the PROSPECT intervention, suggesting potential long-term benefits of treatment and management of depression. (Am J Geriatr Psychiatry 2010; 18:341-350)
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