Brief Interventions to Prevent Depression in Older Subjects: A Systematic Review of Feasibility and Effectiveness

doi:10.1097/JGP.0b013e318162f174

The American Journal of Geriatric Psychiatry

Volume 16, Issue 6, June 2008, Pages 435-443

https://doi.org/10.1097/JGP.0b013e318162f174 Get rights and content

This systematic review proposed to explore the feasibility and effectiveness of brief interventions to prevent depression in older subjects. Computer databases were searched for potentially relevant articles published up until August, 2007. The bibliographies of relevant articles were searched for additional references and all the retrieved articles were screened to meet the following five inclusion criteria: original research, subjects mean age 40 years or more, controlled trial of a brief (<12 weeks) intervention to prevent depression, determination of depression status 6 months or more after enrolment, and use of an acceptable definition of depression. To examine feasibility, study enrolment, completion, and compliance rates were tabulated. To examine effectiveness, differences in depression symptom outcome scores or, when possible, absolute risk reductions (ARR) and relative risk reductions (RRR) for depression were tabulated. Fourteen trials were located. All were trials of brief psychosocial interventions. Many had one or more methodological limitations. Study enrolment rates were 21%–100% (median 45%–49%); completion rates were 53%–100% (median 85%); compliance rates were 29%–100% (median 80%). Eight trials had positive results. In three trials there were significant differences in depression symptom outcome scores favoring the intervention group; in eight trials, ARRs were −17% to 45% (median 6%); RRRs were −125% to 71% (median 33%). It seems that some types of brief psychosocial interventions have the potential to prevent depression in older subjects. Guidelines to improve the quality of future trials are proposed.

Section snippets

METHODS

The selection of articles involved three steps. First, three computer databases, MEDLINE, PsycINFO, and HealthStar, were searched for potentially relevant articles published from January 1966 to February 2005, January 1974 to February 2005, and January 1975 to February 2005, respectively. For MEDLINE and HealthStar, the keywords “depression” (exploded) and “prevention” were used; for PsychINFO, “depression” (exploded) and “primary mental health prevention” were used. To extend this exploration,

RESULTS

In all, the search strategy yielded 559 potentially relevant studies; 108 were retrieved for more detailed evaluation. Fourteen trials met the inclusion criteria. All were trials of brief psychosocial interventions. Ten23, 24, 25, 26, 27, 28, 29, 30, 31, 32 were trials of selective preventive interventions; 233, 34 were trials of indicated interventions; 235, 36 were trials of other types of interventions. The other 94 studies were excluded for the following reasons: 6 did not meet criterion 2,

DISCUSSION

We proposed to extend the exploration of the feasibility and effectiveness of brief interventions to prevent depression in older subjects and develop methodological guidelines to improve the quality of future studies of these types of interventions. We were able to locate 14 trials that met the study inclusion criteria. All were trials of psychosocial interventions. Most were trials of selective preventive interventions. Many had methodological limitations.

As for feasibility, many brief

References (54)

MP Luber et al.
Depression and service utilization in elderly primary care patients
Am J Geriatr Psychiatry
(2001)
MG Cole et al.
The prognosis of depression in old age
Am J Geriatr Psychiatry
(1997)
MG Cole
Evidence-based review of risk factors for geriatric depression and brief preventive interventions
Psychiatr Clin North Am
(2005)
E Allart-van Dam et al.
Prevention of depression in subclinically depressed adults: follow-up effects on the ‘Coping with Depresssion’ course
J Affect Disord
(2007)
A Rasmussen et al.
A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients
Psychosomatics
(2003)
NIH Consensus Development Conference
Diagnosis and treatment of depression in late life
JAMA
(1992)
MG Cole et al.
Pathway to psychiatric care of the elderly with depression
Int J Geriatr Psychiatry
(1996)
D Blazer
Depression in the elderly
N Engl J Med
(1989)
ATF Beekman et al.
The natural history of late-life depression
Arch Gen Psychiatry
(2002)
MG Cole et al.
Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis
Am J Psychiatry
(1999)

BJ Gurland et al.

Depression and disability in the elderly: reciprocal relations and changes with age

Int J Geriatr Psychiatry

(1988)

M Von Korff et al.

Disability and depression among high utilizers of health care: a longitudinal analysis

Arch Gen Psychiatry

(1992)

KB Wells et al.

Caring for depression in America: lessons learned from early findings of the Medical Outcomes Study

Psychiatr Med

(1991)

CM Callahan et al.

Longitudinal study of depression and health services use among elderly primary care patients

J Am Geriatr Soc

(1994)

S Arve et al.

Clinical pathway of elderly persons with lowered mood in the health care services

Scand J Caring Sci

(2000)

NA McKeen et al.

A longitudinal analysis of discrete negative emotions and health-services use in elderly individuals

J Aging Health

(2004)

J Unutzer et al.

Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study

JAMA

(1997)

WJ Katon et al.

Increased medical costs of a population-based sample of depressed elderly patients

Arch Gen Psychiatry

(2003)

J McCusker et al.

Effectiveness of treatments of depression in older ambulatory patients

Arch Intern Med

(1998)

J Unutzer et al.

Collaborative care management of late-life depression in the primary care setting. A randomized controlled trial

JAMA

(2002)

MG Cole et al.

The feasibility and effectiveness of brief interventions to prevent depression in older subjects: a systematic review

Int J Geriatr Psychiatry

(2004)

H Brodaty et al.

Meta-Analysis of psychosocial interventions for caregivers of people with dementia

J Am Geriatr Soc

(2003)

Clinical Epidemiology: A Basic Science for Clinical Medicine

(1991)

GH Guyatt et al.

Users' guides to the medical literature. II. How to use an article about therapy or prevention B. What were the results and will they help me in caring for my patients?

JAMA

(1994)

B Raphael

Preventive intervention with the recently bereaved

Arch Gen Psychiatry

(1977)

CM Parkes

Evaluation of a bereavement service

J Prev Psychiatry

(1981)

BK Haight

Long-term effects of a structured life review process

J Gerontol Psychol Sci

(1992)

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Personalized therapy for depression represents a new frontier in managing depression. For example, brief, nonpharmacologic therapies delivered in primary care settings have shown promise in treating depression30 and in preventing depression in older persons.31 Programs designed to enhance community-based social connection and increase access to mental health services for older adults, such as the STAR program mentioned earlier,13 have also emerged.
Postcard intervention for depression in community-dwelling older adults: A randomised controlled trial
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A 6-year follow-up study showed that 76% of elderly patients with depressive disorder follow either an unfavourable fluctuating or a severe chronic course of depression, and only 23% of patients experience full remission (Beekman et al., 2002). However, no simple and effective interventions currently exist for depression in the community-dwelling elderly population (Cole, 2008). Existing interventions are for patients seen in clinics or hospitals, and they require considerable time and personnel (Burns et al., 2007; Gilden et al., 1992; Haight et al., 1998; Kennedy and Sherazi, 2005; Phillips, 2000; Raphael, 1977; Rovner et al., 2007).
Depression in older adults erodes their health, quality of life and the economy. Existing interventions are not feasible for broad application at the community. Postcard intervention only requires a few resources, and previous studies have shown its effectiveness for patients following drug overdose, self-harm and hospitalisation for major depression. The purpose of the present study is to evaluate the effectiveness of a postcard intervention. Participants were community-dwelling individuals, aged 65 or older, who eat meals alone and with the score of 4 or higher on the 15-item Geriatric Depression Scale (GDS-15). We enrolled 184 eligible participants, with 93 in the intervention and 91 in the control arm. Postcards were sent to participants once a month for eight months. Primary outcome was the GDS-15 score at post-intervention. Secondary outcomes were quality of life and activities of daily living. There was no significant difference in primary and secondary outcomes between completers of the intervention and the control arm. However, most of the participants who received intervention thought the intervention was effective. The postcard intervention for depression in community-dwelling elderly people in Japan is neither feasible nor effective. However, the descriptive results suggest that the intervention may be effective given different parameters.
Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of Mild Cognitive Impairment or early dementia: A randomized controlled trial
2014, American Journal of Geriatric Psychiatry
Interventions directed at the mental health of family dementia caregivers may have limited impact when focused on caregivers who have provided care for years and report high burden levels. We sought to evaluate the mental health effects of problem-solving therapy (PST), designed for caregivers of individuals with a recent diagnosis of Mild Cognitive Impairment (MCI) or early dementia.
Seventy-three (43 MCI and 30 early dementia) family caregivers were randomly assigned to receive PST or a comparison condition (nutritional education). Depression, anxiety, and problem-solving orientation were assessed at baseline and at 1, 3, 6, and 12 months post intervention.
In general, the PST caregiver intervention was feasible and acceptable to family caregivers of older adults with a new cognitive diagnosis. Relative to nutritional education, PST led to significantly reduced depression symptoms, particularly among early dementia caregivers. PST also lowered caregivers' anxiety levels, and led to lessening of negative problem orientation.
Enhanced problem-solving skills, learned early after a loved one's cognitive diagnosis (especially dementia), results in positive mental health outcomes among new family caregivers.
Leisure activity, mobility limitation and stress as modifiable risk factors for depressive symptoms in the elderly: Results of a national longitudinal study
2012, Archives of Gerontology and Geriatrics
Citation Excerpt :
The above results have some implications regarding interventions to prevent late-life depression. In particular, stress management interventions could include promoting the health of older adults living in the community, providing a satisfactory economic status, helping them handle stress from family members or deal with conflict with family members, and cognitive behavioral interventions to reduce negative thinking (Cole, 2008). More mobility limitations was an independent predictor for depressive symptoms, as has been found in other similar studies (Kennedy et al., 1990; Roberts et al., 1997; Yang and George, 2005; Lyness et al., 2009).
Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at follow-up in 2007. The independent variables included demographics, chronic medical diseases and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms assessed at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR = 0.56, 95% confidence interval, CI = 0.38–0.83, p = 0.0034), more mobility limitations (OR = 1.93, 95% CI = 1.30–2.86, p = 0.0011) and higher stress levels (OR = 2.43, 95% CI = 1.68–3.50, p < 0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors.
Prevention of late-life anxiety and depression has sustained effects over 24 months: A pragmatic randomized trial
2011, American Journal of Geriatric Psychiatry
Depressive and anxiety disorders in later life have a high incidence and are associated with reduced quality of life. Elsewhere, we demonstrated that a stepped-care prevention approach was successful in halving the incidence of these disorders over a period of 12 months. As a decreasing effect over time is to be expected, our aim was to investigate the longer-term effects.
Randomized controlled trial.
Thirty-three primary care practices in the Netherlands.
One hundred seventy consenting individuals, age 75 years and older, presenting with subthreshold depression or anxiety, not meeting the diagnostic criteria.
Participants were randomized to a preventive intervention or usual care. In the first 12 months, the preventive intervention entailed watchful waiting, minimally supported CBT-based self-help intervention, problem-solving treatment, and referral to a primary care physician for medication, if required. In the last 12 months, 95% of the participants ceased to receive such support.
Mini International Neuropsychiatric Interview.
The cumulative incidence rate of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depression or anxiety disorder over a period of 24 months was halved by the intervention, from 33 of 84 (39.3%) in the usual care group to 17 of 86 (19.8%) in the intervention group (odds ratio = 0.38; 95% confidence interval = 0.19–0.76), which was significant (z = 2.75; p = 0.006). The corresponding number needed to treat was 5 (95% confidence interval = 3–16).
A stepped-care approach to the prevention of depression and anxiety in late life was not only successful in halving the incidence of depressive and anxiety disorders after 1 year, but these favorable effects were also sustained over 24 months. (Am J Geriatr Psychiatry 2011; 19:230–239)
Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life
2011, American Journal of Geriatric Psychiatry
Citation Excerpt :
In addition, results of the model suggest that the effect of depression on one cognitive ability (processing speed) in turn has an additional effect on other cognitive abilities that interfere with everyday problem solving, a finding supported by the work of Nebes et al.60 In our study, the effects of depressive symptoms (measured by the CES-D) on cognitive abilities and everyday problem solving are small although statistically significant because of large sample size. On the other hand, the change of CES-D score in the clinical setting can be quite large if the patient has severe depressive symptoms or the treatment of depression is effective.63,64 In that case, the effect of depressive symptoms will not be trivial.
The association between depression and functional disability in late life remains unclear. This study aimed to explore the relationship between depressive symptoms and daily functioning through the mediation of cognitive abilities, measured by memory, reasoning, and speed of processing.
The authors recruited 2,832 older adults (mean age = 73.6 years, standard deviation = 5.9) participating in the Advanced Cognitive Training for Independent and Vital Elderly Study. Structural equation modeling was applied to illustrate the relationship between depressive symptoms and everyday problem-solving ability through the mediation of cognitive abilities.
Depressive symptoms were associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning. Although depressive symptoms were associated with speed of processing, speed of processing was not significantly related to everyday problem-solving ability.
This study conceptualizes the possible relationships between depressive symptoms and daily functioning with mediation of cognitive abilities and provides a feasible model for the prevention of functional impairment related to geriatric depressive symptoms.

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Clinical ReviewBrief Interventions to Prevent Depression in Older Subjects: A Systematic Review of Feasibility and Effectiveness

Section snippets

METHODS

RESULTS

DISCUSSION

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Psychiatr Clin North Am

J Affect Disord

Psychosomatics

Diagnosis and treatment of depression in late life

JAMA

Pathway to psychiatric care of the elderly with depression

Int J Geriatr Psychiatry

Depression in the elderly

N Engl J Med

The natural history of late-life depression

Arch Gen Psychiatry

Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis

Am J Psychiatry

Depression and disability in the elderly: reciprocal relations and changes with age

Int J Geriatr Psychiatry

Disability and depression among high utilizers of health care: a longitudinal analysis

Arch Gen Psychiatry

Caring for depression in America: lessons learned from early findings of the Medical Outcomes Study

Psychiatr Med

Longitudinal study of depression and health services use among elderly primary care patients

J Am Geriatr Soc

Clinical pathway of elderly persons with lowered mood in the health care services

Scand J Caring Sci

A longitudinal analysis of discrete negative emotions and health-services use in elderly individuals

J Aging Health

Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study

JAMA

Increased medical costs of a population-based sample of depressed elderly patients

Arch Gen Psychiatry

Effectiveness of treatments of depression in older ambulatory patients

Arch Intern Med

Collaborative care management of late-life depression in the primary care setting. A randomized controlled trial

JAMA

The feasibility and effectiveness of brief interventions to prevent depression in older subjects: a systematic review

Int J Geriatr Psychiatry

Meta-Analysis of psychosocial interventions for caregivers of people with dementia

J Am Geriatr Soc

Clinical Epidemiology: A Basic Science for Clinical Medicine

Users' guides to the medical literature. II. How to use an article about therapy or prevention B. What were the results and will they help me in caring for my patients?

JAMA

Preventive intervention with the recently bereaved

Arch Gen Psychiatry

Evaluation of a bereavement service

J Prev Psychiatry

Long-term effects of a structured life review process

J Gerontol Psychol Sci

Clinical Review
Brief Interventions to Prevent Depression in Older Subjects: A Systematic Review of Feasibility and Effectiveness