Minimally Adequate Treatment for Depression and Anxiety Associated With Mortality in Primary Care Older Adults

Abstract

Objective To assess the association between receipt of minimally adequate treatment (MAT) and mortality in a sample of community primary care older adults with depression and anxiety. Method The present study was conducted among a sample of 358 older adults ( ≥ 65 years old) with depression or an anxiety disorder recruited in primary care practices between 2011 and 2013. Participants agreed to link their health survey and administrative data for the 3 years preceding and following the baseline interview. Depression and anxiety disorders were based on self-reported symptoms aligned with DSM-5 criteria and physician diagnoses (International Classification of Diseases [ICD], 9th and 10th revisions). MAT was defined according to Canadian guidelines and include receipt of pharmacotherapy and ≥ 4 medical visits within 3 months or a number of psychotherapy sessions (individual, group, or family) over 12 months (depression: ≥8; anxiety disorders: ≥5 to 7). All-cause 3-year mortality was ascertained from the vital statistics death registry in Québec. Propensity score weighted regression analysis was conducted to assess the association between receipt of MAT and mortality adjusting for individual, clinical, and health system study factors. Results Receipt of MAT was associated with a reduced risk of mortality (hazard ratio [HR]: 0.27; 95% confidence interval [95% CI], 0.12 to 0.62). Individual and clinical factors associated with increased mortality included older age, male sex, being single, low functional status, and increased physical disorders and cognitive functioning. Lifestyle factors associated with reduced and increased mortality included alcohol consumption and smoking, respectively. Health system factors such as perceived adequate number of visits to speak to the doctor about emotional problems and continuity of care were associated with reduced mortality. Conclusion The current study highlights the important role of primary care physicians in detecting and providing MAT for older adults with depression and anxiety, as this may have an effect on longevity.