Recommendations for Treating Depression in Community-Based Older Adults

Objective

To present recommendations for community-based treatment of late-life depression to public health and aging networks.

Methods

An expert panel of mental health and public health researchers and community-based practitioners in aging was convened in April 2006 to form consensus-based recommendations. When making recommendations, panelists considered feasibility and appropriateness for community-based delivery, as well as strength of evidence on program effectiveness from a systematic literature review of articles published through 2005.

Results

The expert panel strongly recommended depression care management–modeled interventions delivered at home or at primary care clinics. The panel recommended individual cognitive behavioral therapy. Interventions not recommended as primary treatments for late-life depression included education and skills training, comprehensive geriatric health evaluation programs, exercise, and physical rehabilitation/occupational therapy. There was insufficient evidence for making recommendations for several intervention categories, including group psychotherapy and psychotherapies other than cognitive behavioral therapy.

Conclusions

This interdisciplinary expert panel determined that recommended interventions should be disseminated throughout the public health and aging networks, while acknowledging the challenges and obstacles involved. Interventions that were not recommended or had insufficient evidence often did not treat depression primarily and/or did not include a clinically depressed sample while attempting to establish efficacy. These interventions may provide other benefits, but should not be presumed to effectively treat depression by themselves. Panelists also identified primary prevention of depression as a much under-studied area. These findings should aid individual clinicians as well as public health decision makers in the delivery of population-based mental health services in diverse community settings.

a Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, Washington

b Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington

c Senior Services of Seattle/King County, Seattle, Washington

d Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois

e Council for Jewish Elderly, Chicago, Illinois

f Council for Jewish Elderly Adult Day Service Center, Chicago, Illinois

g Division of Community Health and Human Development, University of California at Berkeley School of Public Health, Berkeley, California

h Long Term Care, Philadelphia Corporation for Aging, Philadelphia, Pennsylvania

i College of Social Work, University of South Carolina School of Social Work, Columbia, South Carolina

j Michigan Department of Community Health, Lansing, Michigan

k Department of Social and Behavioral Health, Texas A&M Health Science Center School of Rural Public Health, College Station, Texas

l Salt Lake County Aging Services, Salt Lake City, Utah

m Department of Geriatrics, Baylor College of Medicine, Houston, Texas

n National Association of Social Workers, Washington, DC

Address correspondence and reprint requests to: Mark Snowden, MD, University of Washington, Box 359911, Seattle WA 98104.

PII: S0749-3797(07)00330-3

doi:10.1016/j.amepre.2007.04.034

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