Lisa V. Rubenstein, MD, MSHS; Kimberly A. Hepner, PhD
Potential Financial Conflicts of Interest: None disclosed.
Rubenstein L., Hepner K.; The Importance of Efficient Depression Management in Primary Care. Ann Intern Med. 2008;148:562-563. doi: 10.7326/0003-4819-148-7-200804010-00019
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Published: Ann Intern Med. 2008;148(7):562-563.
We thank Drs. Theleritis and colleagues for pointing out the importance of depression in causing increased mortality due to suicide. As they say, the adverse effects of depression on cardiovascular health and other chronic disease outcomes are well documented. We agree that these effects, in combination with the low quality of care we observed, are cause for alarm. Our comments on mortality related to depression come from a different perspective, however, and we are grateful for the opportunity to clarify.
For many conditions, avoidance of death and hospitalization are critical drivers for quality improvement. For patients hospitalized with congestive heart failure, for example, the observed high short-term rates of death and repeated hospitalization have enabled studies to validate quality improvement programs against both economic and mortality outcomes. In the case of depression, however, hospitalization is relatively rare and effects on death occur over a prolonged period. Also, in our studies, we protect people from death due to suicide by intervening if they disclose significant suicidal risk. So, despite having screened more than 50 000 patients to identify our samples and having enrolled more than 1000 patients with major depression, we have no documented episodes of suicide and few deaths during our period of observation.
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