The benefits of a broader perspective in case-finding for disease management of depression: early lessons from the PROSPECT Study

The PROSPECT (Prevention of Suicide in Primary Care Elderly - Collaborative Trial) Study evaluates collaborative care for the treatment of current dep ressive disorders in older primary care patients. Using screening data, we evaluate implications of expanding the focus to additional patients who rep ort taking psychotropic medication or having a history of depression. Some 13.8% of the patients screened were taking a psychotropic medication and 7. 3% were both taking an antidepressant and had a Center for Epidemiologic St udies - Depression Scale (CES-D) score of > 15. Patients who reported curre nt antidepressant use and those with a history of depression also had eleva ted CES-D scores. Conversely, most patients having an elevated CES-D score also reported taking an antidepressant or having a history of depression. T hese latter criteria for potential caseness yielded a larger number of pati ents than those identified by the CES-D alone. More comprehensive approache s to the management of depression should attend to patients already taking psychotropic medication and symptomatic patients with a history of depressi on, as well as those with current syndromal depression. Copyright (C) 2001 John Wiley & Sons, Ltd.