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To the Editor: Dr Bruce and colleagues¹ reported that, compared with usual care, presence of a depression specialist in primary care practices resulted in reduced suicidal ideation and a more favorable clinical course among elderly patients with major and minor depression. I am concerned, however, that patients in the intervention condition had access not only to a depression specialist, but to free medication and psychotherapy. The patients who received routine care had neither. Thus, it is not clear how much of the clinical effect was due to the presence of the specialist, particularly as patients in the intervention group were approximately 4 times more likely to receive any treatment than those in routine care.

Although the authors claimed that the intervention reduced suicidal ideation, this is of uncertain clinical significance. The Scale for Suicide Ideation, which the authors used, has been not shown to be a predictor of suicide in . . . [Full Text of this Article]

James C. Coyne, PhD
jcoyne@mail.med.upenn.edu
Department of Psychiatry
University of Pennsylvania Health System
Philadelphia