Non-pharmacological prevention of major depression among community-dwelling older adults: A systematic review of the efficacy of psychotherapy interventions
ABSTRACT Depression is a major public health burden among the aging population. While older adults prefer non-pharmacological treatment, few options for psychotherapy are available in primary care settings, which is where older adults tend to receive mental health services. Indicated prevention is a cost-effective, public health approach to prevent major depressive disorder among people with depressive symptoms who do not yet meet standard criteria for major depression. We critically reviewed randomized controlled trials (RCTs) that assessed the efficacy of psychotherapy among community-dwelling older adults with subthreshold depression (depressive symptoms that do not meet standard criteria for major depression). We examined the intervention types, results, internal validity, and external validity of five studies. We used the United States Preventive Services Task Force (USPSTF) guidelines to rate the quality of the studies and to provide recommendations. Results suggest that psychotherapy is a safe and cost-effective method to reduce the public health burden of depression among older adults with subthreshold depression.
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ABSTRACT: Co-Author, "Harvest Health: Translation of the Chronic Disease Self-Management Program for Older African Americans in a Senior Setting”, The Gerontologist (Oct. 2008)
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ABSTRACT: Chinese translation Effective care models for treating older African Americans with depressive symptoms are needed. To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans. Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680) SETTING: A senior center and participants' homes from 2008 to 2010. African Americans aged 55 years or older with depressive symptoms. A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months. Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months. Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, -2.9 [95% CI, -4.6 to -1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, -3.7 [CI, -5.4 to -2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months. The study had a small sample, short duration, and differential withdrawal rate. A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans. National Institute of Mental Health.Annals of internal medicine 08/2013; 159(4):243-52. DOI:10.7326/0003-4819-159-4-201308200-00005 · 16.10 Impact Factor
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ABSTRACT: Objective: To evaluate the effect of a dance-based therapy on depressive symptoms among institutionalized older adults. Design: Randomized controlled trial. Setting: Nursing homes. Participants: Older adults (60 years or older) permanently living in a nursing home. Intervention: Exercise Dance for Seniors (EXDASE) Program designed for the use in long-term care settings performed once a week for 60 minutes for 3 months. Measurements: Baseline measures included sociodemographic characteristics, ability to perform basic as well as instrumental activities of daily living, basic mobility, self-rated health, and cognitive status. Outcome measures were collected before and after the intervention and included assessment of depressive symptoms using the geriatric depression scale (GDS). Results: Comparison of participants with MMSE of 15 or higher showed that GDS scores in the intervention group significantly improved (P = .005), whereas the control group had a trend of further worsening of depressive symptoms (P = .081). GLM analysis documented highly statistically significant effect of dance therapy (P = .001) that was not influenced by controlling for intake of antidepressants and nursing home location. Dance therapy may have decreased depressive symptoms even in participants with MMSE lower than 15 and resulted in more discontinuations and fewer prescriptions of antidepressants in the intervention group than in the control group. Conclusion: This study provides evidence that dance-based exercise can reduce the amount of depressive symptoms in nursing home residents. In general, this form of exercise seems to be very suitable and beneficial for this population. (C) 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Journal of the American Medical Directors Association 06/2014; 15(8). DOI:10.1016/j.jamda.2014.04.013 · 4.78 Impact Factor