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Abstract

A randomized trial found that older adults with subsyndromal depression who received problem-solving therapy for primary care (PST-PC) avoided developing major depression for two years. But in an unexpected finding, so did a comparison group of patients who received only dietary counseling. Even though dietary counseling did not address depression per se, the authors speculated that it provided some of the same active features as PST-PC, including homework assignments and monitoring of adherence. Both interventions are suitable for delivery by lay health counselors, making use in primary care settings easier.

Abstract

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.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Griselda, by Maxfield Parrish. © Copyright 2014 National Museum of American Illustration™, Newport, Rhode Island. Photos courtesy of Archives of the American Illustrators Gallery™, New York City.

Psychiatric Services
Pages: 765 - 773
PubMed: 24632760

History

Published in print: June 2014
Published online: 15 October 2014

Authors

Details

Charles F. Reynolds, III, M.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Stephen B. Thomas, Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Jennifer Q. Morse, Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Stewart J. Anderson, Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Steven Albert, Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Mary Amanda Dew, Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Amy Begley, M.A.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Jordan F. Karp, M.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Ariel Gildengers, M.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Meryl A. Butters, Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Jacqueline A. Stack, M.S.N.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
John Kasckow, M.D., Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Mark D. Miller, M.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.
Sandra C. Quinn, Ph.D.
Dr. Reynolds, Dr. Morse, Dr. Dew, and Ms. Begley through Dr. Miller are with the Department of Psychiatry, University of Pittsburgh School of Medicine (Western Psychiatric Institute and Clinic), Pittsburgh, Pennsylvania (e-mail: [email protected]). Dr. Kasckow is also with the Department of Behavioral Health, Veterans Affairs Pittsburgh Health Care System. Dr. Thomas and Dr. Quinn are with the Center for Health Equity, University of Maryland, College Park. Dr. Anderson is with the Department of Biostatistics, University of Pittsburgh Graduate School of Public Health. Dr. Albert is with the Department of Behavioral and Community Health Science, University of Pittsburgh.

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