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Prevention of Major Depression in Complex Medically Ill Patients: Preliminary Results From a Randomized, Controlled Trial

Received January 25, 2008; revised April 4, 2008; accepted April 7, 2008. From the Dept. of Internal Medicine and Dept. of Psychiatry, University Medical Centre, Groningen University of Groningen, The Netherlands, Service de Psychiatrie de Liaison, University Hospital of Lausanne, Switzerland; Service de Rhumatologie, University Hospital of Lausanne, Switzerland; and the Division d’Endocrinologie et de Métabolisme, University Hospital of Lausanne, Switzerland. Send correspondence and reprint requests to Peter de Jonge, Ph.D., Dept. of Psychiatry; University of Groningen, P.O. Box 30.001; 9700 RB Groningen, The Netherlands. e-mail: peter.de.jonge{at}med.umcg.nl
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Depression is highly prevalent in patients with physical illness and is associated with a diminished quality of life and poorer medical outcomes. OBJECTIVE: The authors evaluated whether a multifaceted intervention conducted by a psychiatric consultation–liaison nurse could reduce the incidence of major depression in rheumatology inpatients and diabetes outpatients with a high level of case complexity. METHOD: Of 247 randomized patients, the authors identified 100 patients with a high level of case complexity at baseline and without major depression (65 rheumatology and 35 diabetes patients). Patients were randomized to usual care (N=53) or to a nurse-led intervention (N=47). Main outcomes were the incidence of major depression and severity of depressive symptoms during a 1-year follow-up, based on quarterly assessments with standardized psychiatric interviews. RESULTS: The incidence of major depression was 63% in usual-care patients and 36% in the intervention group. Effects of intervention on depressive symptoms were observed in outpatients with diabetes but not in rheumatology inpatients. CONCLUSION: These preliminary results based on subgroup analysis suggest that a multifaceted nurse-led intervention may prevent the occurrence of major depression in complex medically ill patients and reduce depressive symptoms in diabetes outpatients.

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