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Articles   |    
Early Intervention to Preempt Major Depression Among Older Black and White Adults
Charles F. Reynolds, III, M.D.; Stephen B. Thomas, Ph.D.; Jennifer Q. Morse, Ph.D.; Stewart J. Anderson, Ph.D.; Steven Albert, Ph.D.; Mary Amanda Dew, Ph.D.; Amy Begley, M.A.; Jordan F. Karp, M.D.; Ariel Gildengers, M.D.; Meryl A. Butters, Ph.D.; Jacqueline A. Stack, M.S.N.; John Kasckow, M.D., Ph.D.; Mark D. Miller, M.D.; Sandra C. Quinn, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300216
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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: reynoldscf@upmc.edu). 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.

Copyright © 2014 by the American Psychiatric Association

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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Figure 1 Two-year BDI scores of older adults receiving problem-solving therapy for primary care (PST-PC) or dietary coachinga

a Participants in both conditions demonstrated similar improvement in depressive symptoms, as measured with the Beck Depression Inventory (BDI). Asterisks indicate when a booster session was given. The top panel is for the overall group of 247, which included three Asian participants. There was a significant quadratic effect and linear time effects (F=75.91, dfs=1 and 1,356, p<.001, and F=159.57, dfs=1 and 1,356, p<.001, respectively) but no significant intervention or intervention × time effects. Examination of race as a moderator (bottom panels) showed baseline racial differences between interventions, and covarying the model for baseline score (Pre) resulted in a significant time effect (F=26.78, dfs=1 and 1,115, p<.001) for postintervention (Post) through two years, but no other significant effects. BDI scores can range from 0 to 63, with higher scores indicating more depressive symptoms. Vertical lines represent standard errors.

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Table 1Characteristics of older adults receiving problem-solving therapy for primary care (PST-PC) or dietary coaching
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a Fisher exact p value reported

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b Possible scores range from 0 to 52, with higher scores indicating more medical burden.

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c Possible scores range from 0 to 13, with higher scores indicating more medical burden.

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d Possible scores range from 0 to 8, with higher scores indicating more medical burden.

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e Possible scores range from 0 to 100, with higher scores indicating better health.

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f Possible scores range from 0 to 30, with higher scores indicating more cognitive impairment.

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g Possible scores range from 0 to 52, with higher scores indicating more depressive symptoms.

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h Possible scores range from 0 to 60, with higher scores indicating more depressive symptoms.

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i Possible scores range from 0 to 63, with higher scores indicating more depressive symptoms.

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j Possible scores range from 0 to 4, with higher scores indicating more anxiety symptoms.

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k Possible scores for Total range from 29 to 139 and those for positive problem orientation range from 52 to 135, with higher scores on each scale indicating better problem solving.

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l Referrals came from the Kingsley Center, Healthy Black Family Project, Healthy Hearts and Souls, grocery store screening, or a barbershop.

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Table 2Characteristics of older adults receiving problem-solving therapy for primary care (PST-PC) or dietary coaching, by race
Table Footer Note

a Fisher exact p value reported

Table Footer Note

b Possible scores range from 0 to 52, with higher scores indicating more medical burden.

Table Footer Note

c Possible scores range from 0 to 13, with higher scores indicating more medical burden.

Table Footer Note

d Possible scores range from 0 to 8, with higher scores indicating more medical burden.

Table Footer Note

e Possible scores range from 0 to 100, with higher scores indicating better health.

Table Footer Note

f Possible scores range from 0 to 30, with higher scores indicating more cognitive impairment.

Table Footer Note

g Possible scores range from 0 to 52, with higher scores indicating more depressive symptoms.

Table Footer Note

h Possible scores range from 0 to 60, with higher scores indicating more depressive symptoms.

Table Footer Note

i Possible scores range from 0 to 63, with higher scores indicating more depressive symptoms.

Table Footer Note

j Possible scores range from 0 to 4, with higher scores indicating more anxiety symptoms.

Table Footer Note

k Possible scores for Total range from 29 to 139 and those for positive problem orientation range from 52 to 135, with higher scores on each scale indicating better problem solving.

Table Footer Note

l Referrals came from the Kingsley Center, Healthy Black Family Project, Healthy Hearts and Souls, grocery store screening, or a barbershop.

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References

Cuijpers  P;  Beekman  ATF;  Reynolds  CF  III:  Preventing depression: a global priority.  JAMA 307:1033–1034, 2012
 
Reynolds  CF  III;  Cuijpers  P;  Patel  V  et al:  Early intervention to reduce the global health and economic burden of major depression in older adults; in  Annual Review of Public Health . Edited by Fielding  JE;  Brownson  RC;  Green  LW.  Palo Alto, Calif,  Annual Reviews, 2012
 
Diniz  BS;  Butters  MA;  Albert  SM  et al:  Late-life depression and risk of vascular dementia and Alzheimer’s disease: systematic review and meta-analysis of community-based cohort studies.  British Journal of Psychiatry 202:329–335, 2013
 
Jang  Y;  Borenstein  AR;  Chiriboga  DA  et al:  Depressive symptoms among African American and white older adults.  Journals of Gerontology: Series B, Psychological Sciences and Social Sciences 60:P313–P319, 2005
 
Sriwattanakomen  R;  McPherron  J;  Chatman  J  et al:  A comparison of the frequencies of risk factors for depression in older black and white participants in a study of indicated prevention.  International Psychogeriatrics 22:1240–1247, 2010
 
Mental Health: Culture, Race and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Md, Department of Health and Human Services, 2001
 
Shadlen  MF;  Siscovick  DS;  Fitzpatrick  AL  et al:  Education, cognitive test scores, and black-white differences in dementia risk.  Journal of the American Geriatrics Society 54:898–905, 2006
 
Barnes  DE;  Yaffe  K:  The projected effect of risk factor reduction on Alzheimer’s disease prevalence.  Lancet Neurology 10:819–828, 2011
 
Williams  DR:  Race, stress, and mental health; in  Minority Health in America: Findings and Policy Implications From Commonwealth Fund Minority Health Survey . Edited by Hogue  CJR;  Hargraves  MA;  Collis  KS.  Baltimore,  Johns Hopkins University Press, 2000
 
Steffens  DC;  Artigues  DL;  Ornstein  KA  et al:  A review of racial differences in geriatric depression: implications for care and clinical research.  Journal of the National Medical Association 89:731–736, 1997
 
Cuijpers  P;  de Graaf  R;  van Dorsselaer  S:  Minor depression: risk profiles, functional disability, health care use and risk of developing major depression.  Journal of Affective Disorders 79:71–79, 2004
 
Muñoz  RF;  Ying  YW;  Bernal  G  et al:  Prevention of depression with primary care patients: a randomized controlled trial.  American Journal of Community Psychology 23:199–222, 1995
 
Smit  F;  Ederveen  A;  Cuijpers  P  et al:  Opportunities for cost-effective prevention of late-life depression: an epidemiological approach.  Archives of General Psychiatry 63:290–296, 2006
 
Cole  MG:  Evidence-based review of risk factors for geriatric depression and brief preventive interventions.  Psychiatric Clinics of North America 28:785–803, 2005
 
Schoevers  RA;  Smit  F;  Deeg  DJH  et al:  Prevention of late-life depression in primary care: do we know where to begin? American Journal of Psychiatry 163:1611–1621, 2006
 
Cooper-Patrick  L;  Gallo  JJ;  Gonzales  JJ  et al:  Race, gender, and partnership in the patient-physician relationship.  JAMA 282:583–589, 1999
 
Fournier  JC;  DeRubeis  RJ;  Hollon  SD  et al:  Antidepressant drug effects and depression severity: a patient-level meta-analysis.  JAMA 303:47–53, 2010
 
Stewart  JA;  Deliyannides  DA;  Hellerstein  DJ  et al:  Can people with nonsevere major depression benefit from antidepressant medication? Journal of Clinical Psychiatry 73:518–525, 2012
 
Unützer  J;  Katon  W;  Callahan  CM  et al:  Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.  JAMA 288:2836–2845, 2002
 
Nezu  AM;  Nezu  CM:  Problem solving therapy.  Journal of Psychotherapy Integration 11:187–205, 2001
 
Rovner  BW;  Casten  RJ;  Hegel  MT  et al:  Preventing depression in age-related macular degeneration.  Archives of General Psychiatry 64:886–892, 2007
 
Robinson  RG;  Jorge  RE;  Moser  DJ  et al:  Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial.  JAMA 299:2391–2400, 2008
 
Alexopoulos  GS;  Raue  P;  Areán  PA:  Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction.  American Journal of Geriatric Psychiatry 11:46–52, 2003
 
Radloff  LS:  The CES-D Scale: a self-report depression scale for research in the general population.  Applied Psychological Measurement 1:385–401, 1977
 
First  M;  Spitzer  RL;  Gibbon  M  et al:  Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Version 2.0 .  New York,  New York State Psychiatric Institute, 1994
 
Folstein  MF;  Folstein  SE;  McHugh  PR:  “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician.  Journal of Psychiatric Research 12:189–198, 1975
 
Beck  AT;  Ward  CH;  Mendelson  M  et al:  An inventory for measuring depression.  Archives of General Psychiatry 4:561–571, 1961
 
Ware  J:  SF-36 Health Survey. Manual and Interpretation Guide 2 .  Boston,  Health Institute, New England Medical Center, Nimrod Press, 1997
 
Miller  MD;  Paradis  CF;  Houck  PR  et al:  Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale.  Psychiatry Research 41:237–248, 1992
 
D’Zurilla  TJ;  Nezu  AM:  Development and preliminary evaluation of the Social Problem-Solving Inventory.  Psychological Assessment 2:156–163, 1990
 
Derogatis  LR;  Melisaratos  N:  The Brief Symptom Inventory: an introductory report.  Psychological Medicine 13:595–605, 1983
 
D’Zurilla  TJ;  Nezu  AM:  Problem-Solving Therapy: A Positive Approach to Clinical Intervention .  New York,  Springer, 2007
 
Lyness  JM;  Heo  M;  Datto  CJ  et al:  Outcomes of minor and subsyndromal depression among elderly patients in primary care settings.  Annals of Internal Medicine 144:496–504, 2006
 
Bruce  ML;  Ten Have  TR;  Reynolds  CF  III  et al:  Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial.  JAMA 291:1081–1091, 2004
 
Lyness  JM;  Yu  Q;  Tang  W  et al:  Risks for depression onset in primary care elderly patients: potential targets for preventive interventions.  American Journal of Psychiatry 166:1375–1383, 2009
 
van’t Veer-Tazelaar  PJ;  van Marwijk  HW;  van Oppen  P  et al:  Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial.  Archives of General Psychiatry 66:297–304, 2009
 
Patel  V;  Weiss  HA;  Chowdhary  N  et al:  Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial.  Lancet 376:2086–2095, 2010
 
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