The Wish to Die and 5-Year Mortality in Elderly Primary Care Patients

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)