Reducing depression and suicide amongst older Australians: a clustered randomised clinical trial in primary health care (DEPS-GP Project)
Funding Source: National Health and Medical Research Council of Australia (NHMRC)
Aims
The primary aim of the study is to determine whether an educational intervention targeting Australian general practitioners (GPs) can reduce the prevalence of depression, suicide ideation and self-harm behaviour in later life. More specifically, the study aims to test the following hypotheses: (1) Older adults attending GPs randomised to receive the intervention will be less likely to meet criteria for a major depressive episode at 12 and 24 months follow-up than older adults attending control GPs; (2) Older adults attending GPs randomised to receive the intervention will be less likely to report suicide ideation at 12 and 24 months follow-up than older adults attending control GPs; (3) Older adults attending GPs randomised to the intervention group will be less likely to attempt or complete suicide during the 24-month follow-up period than older adults attending control GPs.
Background
Like many industrialised nations, Australia's population is ageing. By the year 2051, the population aged 65 years and over is projected to triple in size, while those over 85 will increase five-fold. The social, financial and health consequences of a rapidly ageing society cannot be ignored. Depression is common in later life. The presence of depressive symptoms complicates the clinical course of several medical conditions associated with older age, and is also associated with increased mortality in later life. Suicide rates are particular high in later life, and depression has been found to be the most robust factor associated with suicide in this age group. Antidepressant treatment has good efficacy in later life and its appropriate use decreases the risk of relapse and recurrence of symptoms, as well as reducing suicidal ideation and behaviour amongst the aged. The vast majority of older adults in Australia visit their GP at least once per year, while up to 83% of those who die by suicide have contact with their doctor in the months prior to their death, highlighting the major role that GPs might play in the management of depression and prevention of suicide.
Significance
The personal and social costs associated with depression are well known and, as a result, it is not surprising that health authorities have identified depression as the leading cause of years of life lost due to disability in Australia. In addition, attempted and completed suicide in later life are very closely associated with depression, so that adequate diagnosis and treatment of depression should lead to a significant decline in the burden of illness and contribute to the reduction of suicide and attempted suicide rates. At present, however, we still lack direct evidence for such a link. The present study has been conceived to have sufficient power to directly answer such a question and, hopefully, produce relevant information for the introduction of sound public health strategies designed with the aim of reducing the significant human and social costs associated with depression in later life.
Research Plan and Outcomes of Interest
This clustered randomised controlled clinical trial has recruited a stratified random sample of 403 Australian GPs and 23,000 of their patients. Detailed information about study design, recruitment procedure and assessment can be found in this BMC Medical Research Methodology article.
Chief Investigators
- Professor Osvaldo Almeida
- Dr Jon Pfaff
- Associate Professor Ngaire Kerse
- Clinical Professor John Snowdon
- Professor Robert Goldney
- Associate Professor Jane Pirkis
Associate Investigators
- Associate Professor Moira Sim
- Associate Professor Gerard Byrne
- Associate Professor Brian Draper
- Professor Leon Flicker
- Professor Nicola Lautenschlager
- Professor Ian Wilson
- Professor Nigel Stocks
