Depression in late-life: shifting the paradigm from treatment to prevention
ABSTRACT Late-life depression is very common and is associated with high rates of morbidity and mortality. While the field of geriatric psychiatry is focused on depression treatment, prevention is an enticing option. Prevention of late-life depression would decrease both emotional suffering and depression-associated morbidity and mortality and may decrease dependence on non-mental health professionals to detect depression and to initiate a treatment referral. This paper will review current thinking on prevention research with a particular focus on its application to late-life depression. To illustrate these issues, we discuss recent and ongoing clinical trials of interventions to prevent depression in two populations of older persons: those with age-related macular degeneration (AMD) and those with cerebrovascular disease.
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ABSTRACT: The Major Contribution aimed at strengthening a prevention focus in psychology, so as to more effectively and equitably promote the well-being of all members of psychology communities. The 3 reactions (L. A. Bond & A. Carmola Hauf, 2007 [this issue]; L. Reese, 2007 [this issue]; E. Rivera-Mosquera, E. T. Dowd, & M. Mitchell-Blanks 2007 [this issue]) give strong support for the best practice prevention guidelines, while providing new insights for their implementation in the field of psychology. In this rejoinder, the authors make an effort to build upon their colleagues' ideas, by addressing the topics of community-based collaboration, prevention across the life span, and implementation of the best practice guidelines. The authors urge further interdisciplinary collaboration by members of the American Psychological Association, and others interested in prevention, and invite genuine action to expand prevention efforts.The Counseling Psychologist 07/2007; 35(4):594-604. DOI:10.1177/0011000006297158 · 1.82 Impact Factor
Article: Bibliography G ERIATRIC P SYCHIATRY
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ABSTRACT: To explore the feasibility and effectiveness of brief interventions to prevent depression in older subjects. MEDLINE, PsycINFO and HealthStar were searched for potentially relevant articles published from January 1966 to June 2003, January 1974 to June 2003 and January 1975 to June 2003, respectively. The bibliographies of relevant articles were searched for additional references. Ten studies met the following five inclusion criteria: original research, subjects mean age 50 years or more, controlled trial of a brief (<12 weeks) intervention to prevent depression, determination of depression status 12 months or more after enrolment, use of an acceptable definition of depression. The validity of studies was assessed according to six criteria. To examine feasibility we tabulated study enrolment, completion and compliance rates. To examine effectiveness we tabulated differences in depression symptom outcome scores between intervention and control groups or, when possible, absolute (ARR) and relative (RRR) risk reductions for depression. Only two of the ten trials met all of the validity criteria. Study enrolment rates were 21 to 100% (median 72.5%); study completion rates were 46% to 100% (median 85%); compliance rates were 29% to 100% (median 87%). Five of the ten trials had positive results: in two trials there were statistically significant differences in depression symptom outcome scores favoring the intervention group; in three trials ARRs were 2.3% to 45% (median 17%); RRRs were 45% to 71% (median 61%). Some types of brief interventions appear to have the potential to prevent depression in older subjects. Despite the methodologic limitations of the trials and this systematic review, these findings may guide efforts to develop and evaluate brief interventions to prevent depression in this population.International Journal of Geriatric Psychiatry 11/2004; 19(11):1019-25. DOI:10.1002/gps.1200 · 3.09 Impact Factor