Capsule Commentary on Gallo et al., Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

Journal of General Internal Medicine, Feb 2016

Jeffrey L. Jackson MD MPH, Cynthia Kay MD MSc

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Capsule Commentary on Gallo et al., Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

Published online February Capsule Commentary on Gallo et al., Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk Jeffrey L. Jackson 0 Cynthia Kay 0 Zablocki VAMC 0 Milwaukee 0 0 Compliance with Ethical Standards: - O isolates studies to a narrow class of patients and a single ne problem in translational research is that it usually disease. However, as Gallo correctly points out, older adult patients usually present with multiple comorbid diseases, each with their own management algorithm.1 Such algorithms sometimes suggest strategies for the index disease that might complicate or be contraindicated in patients with comorbid conditions. Primary care physicians are used to dealing with and balancing multiple competing needs of their older patients. Depression commonly complicates disease and numerous observational studies have shown that when present, comorbid depression increases mortality. Unfortunately, subsequent randomized trials of depression management have failed to show a survival benefit. For example, regarding cardiovascular disease, observational studies have found that patients with depression have increased mortality,2 but randomized controlled trials (RCTs) on managing depression in patients with heart failure or post myocardial infarction have failed to demonstrate a mortality benefit.3 Gallo et al. provide yet more observational data that improved depression care may save lives. They randomized depressed patients to usual care or more intensive management, and found that depressed participants randomized to usual care with high levels of medical comorbidity were three times more likely to die than those with depression and minimal medical comorbidity. Patients receiving more intensive depression managed with high disease burden experienced a nonsignificant morality rate that was 1.75 times greater than that among those with depression and low levels of medical comorbidity. The authors conclude that, Bdepression management mitigated the combined effect of multimorbidity and depression on mortality^ and Bshould be integral to optimal patient care, not a secondary focus.^1 That depression management should be integral to optimal patient care is not an argument that needs buttressing. Depression has a profound impact on the lives of the individual, their family and the workplace. Depression is most commonly managed in primary care and every provider has experienced the remarkable improvement in the quality of their patient’s life with appropriate depression management. This endless, and thus far fruitless, search for an additional mortality reason to justify making depression management an integral skill for primary care physicians seems unnecessary and misguided. Conflict of Interest: The authors have no conflicts of interest with this article. 1. Gallo JJ , Hwang S , Joo JH , Bogner HR , Morales KH , Bruce ML , Reynolds CF . Multimorbidity, depression, and mortality in primary care: randomized clinical trial of an evidence-based depression care management program on mortality risk . J Gen Intern Med . 2015 . doi: 10 .1007/s11606- 015-3524-y. 2. Meijer A , Conradi HJ , Bos EH , Thombs BD , van Melle JP , et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25years of research . Gen Hosp Psychiatry . 2011 ; 333 : 203 - 216 . 3. Thombs BD , Roseman M , Coyne JC , Jonge PD , Delisle VC , Arthurs E , Levis B , Ziegelstein RC . does evidence support the american heart association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review . PLoS One . 2013 ; 8 ( 1 ): e52654 .


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Jeffrey L. Jackson MD MPH, Cynthia Kay MD MSc. Capsule Commentary on Gallo et al., Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk, Journal of General Internal Medicine, 2016, 412-412, DOI: 10.1007/s11606-016-3589-2