Non-pharmacological prevention of major depression among community-dwelling older adults: A systematic review of the efficacy of psychotherapy interventions

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Archives of gerontology and geriatrics (Impact Factor: 1.85). 04/2012; 55(3):522-9. DOI: 10.1016/j.archger.2012.03.003
Source: PubMed


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.

21 Reads
  • Source
    • "There is a general consensus that a broad range of psychosocial treatments are efficacious for treating psychological disorders in later life (Scogin & Shah, 2012). A series of meta-analyses and reviews supported the efficacy of psychosocial treatments for depression and anxiety in latemiddle aged to older adults (e.g., Gonçalves & Byrne, 2012; Lee et al., 2012). Researchers currently assert that intense and complex treatments such as prolonged exposure therapy are effective for older individuals (Clapp & Beck, 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Whether psychosocial treatments work equally well for late middle-aged and older men and women is unknown. For this critical review, sixteen studies were identified that examined psychosocial treatments for psychopathology in men age 55 and older. The preponderance of evidence showed that treatments worked at least as well in men as in women. Six studies reported statistically significant treatment effects in exclusively male participants. Methodological problems include weak research designs, small sample size, and absence of indication of clinical significance. There continues to be a paucity of research addressing the efficacy of psychosocial interventions for late middle-aged and older men. Researchers are encouraged to include racially and ethnically diverse older men in carefully controlled studies that examine clinically significant change. (120 words) Keywords: Psychotherapy, Gender Differences, Men, Psychosocial Intervention, Older adults
    Full-text · Article · Jun 2015 · GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry
  • Source
    [Show abstract] [Hide abstract]
    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)
    Full-text · Article · Jan 2006
  • Source
    [Show abstract] [Hide abstract]
    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. ( 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.
    Full-text · Article · Aug 2013 · Annals of internal medicine
Show more