Early Intervention to Preempt Major Depression Among Older Black and White Adults

被引:40
|
作者
Reynolds, Charles F., III [1 ]
Thomas, Stephen B. [3 ]
Morse, Jennifer Q. [1 ]
Anderson, Stewart J. [4 ]
Albert, Steven [5 ]
Dew, Mary Amanda [1 ]
Begley, Amy [1 ]
Karp, Jordan F. [1 ]
Gildengers, Ariel [1 ]
Butters, Meryl A. [1 ]
Stack, Jacqueline A. [1 ]
Kasckow, John [1 ,2 ]
Miller, Mark D. [1 ]
Quinn, Sandra C. [3 ]
机构
[1] Univ Pittsburgh, Western Psychiat Inst & Clin, Dept Psychiat, Sch Med, Pittsburgh, PA 15213 USA
[2] Vet Affairs Pittsburgh Hlth Care Syst, Dept Behav Hlth, Pittsburgh, PA USA
[3] Univ Maryland, Ctr Hlth Equ, College Pk, MD 20742 USA
[4] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
[5] Univ Pittsburgh, Dept Behav & Community Hlth Sci, Pittsburgh, PA USA
基金
美国国家卫生研究院;
关键词
LATE-LIFE DEPRESSION; PROBLEM-SOLVING THERAPY; PRIMARY-CARE PATIENTS; PREVENTING DEPRESSION; GERIATRIC DEPRESSION; RISK-FACTORS; SYMPTOMS; DEMENTIA; ANXIETY;
D O I
10.1176/appi.ps.201300216
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective: The study objective was to assess the efficacy of problem-solving therapy for primary care (PST-PC) for preventing episodes of major depression and mitigating depressive symptoms of older black and white adults. The comparison group received dietary coaching. Methods: A total of 247 participants (90 blacks, 154 whites, and three Asians) with subsyndromal depressive symptoms were recruited into a randomized depression prevention trial that compared effects of individually delivered PST-PC and dietary coaching on time to major depressive episode and level of depressive symptoms (Beck Depression Inventory) over two years. Cumulative intervention time averaged 5.5-6.0 hours in each study arm. Results: The two groups did not differ significantly in time to major depressive episodes, and incidence of such episodes was low (blacks, N=8, 9%; whites, N=13, 8%), compared with published rates of 20%-25% over one year among persons with subsyndromal symptoms and receiving care as usual. Participants also showed a mean decrease of 4 points in depressive symptoms, sustained over two years. Despite greater burden of depression risk factors among blacks, no significant differences from whites were found in the primary outcome. Conclusions: Both PST-PC and dietary coaching are potentially effective in protecting older black and white adults with subsyndromal depressive symptoms from developing episodes of major depression over two years. Absent a control for concurrent usual care, this conclusion is preliminary. If confirmed, both interventions hold promise as scalable, safe, nonstigmatizing interventions for delaying or preventing episodes of major depression in the nation's increasingly diverse older population.
引用
收藏
页码:765 / 773
页数:9
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