Preventing depression in homes for older adults: are effects sustained over 2 years?

Pessoas idosas institucionalizadas, transtornos depressivos e questões odontológicas: qual o estado da arte?

Resumo Objetivo Fazer um mapeamento e uma discussão sobre o conhecimento científico envolvendo o objeto de pesquisa Condições de saúde bucal e depressão em idosos institucionalizados. Método Revisão de Escopo do tipo mapeamento da literatura. O mapeamento dos dados selecionados foi feito pela técnica de sistematização de dados por meio da Análise de Conteúdo Somativa na perspectiva de Temas Manifestos nos textos. Após as exclusões foram selecionados 27 artigos. Resultados Com a análise dos artigos foi possível dividi-los em dois temas. Todos os continentes possuem publicações acerca do tema. Sobre sua metodologia, muitas pesquisas com desenho de estudos dedutivos foram realizadas e poucas pesquisas foram desenvolvidas com métodos indutivos. Conclusão O presente estudo identificou que existe uma interlocução entre algumas condições de saúde bucal (xerostomia e perda dentária) e prevalência de transtornos depressivos em idosos institucionalizados.

Problem-solving intervention to prevent depression in non-professional caregivers: a randomized controlled trial with 8 years of follow-up

BACKGROUND

Studies of psychological interventions for the prevention of depression have found significant effects in the short-term, but the long-term efficacy has yet to be determined. This study evaluated the 8-year effect of a randomized controlled trial for indicated prevention of depression in female caregivers.

METHODS

A total of 173 non-professional female caregivers with subclinical depressive symptoms not meeting criteria for a major depressive episode (MDE) were randomized to either a brief problem-solving intervention (n = 89) or usual-care control group (n = 84). Blinded evaluators conducted an assessment at the 8-year follow-up. The primary outcome was Depression Status, defined by diagnoses of MDE since the 1-year follow-up using the Structured Clinical Interview for the Disorders of the DSM-5. The secondary outcome was current Depressive Symptom Severity. Regression analyses were conducted to evaluate the effect of the intervention on the outcomes.

RESULTS

There were no significant differences in the Depression Status between the problem-solving (30.3%) and control groups (26.2%) (adjusted OR 1.25, 95% CI -0.58 to 2.69). Depressive Symptom Severity, however, was significantly lower in the problem-solving group compared to the control group at this follow-up, amounting to a small effect size of Cohen's d = 0.39 (adjusted B = -3.32, p = 0.018).

CONCLUSIONS

This is the first study to assess such a long-term follow-up of intervention of indicated prevention of depression. Results seem to indicate that the protective effect of the intervention became smaller over time during follow-up. Future research should replicate these results.

Improving mental healthcare for the elderly in Belgium

INTRODUCTION

The organisation of mental healthcare for the elderly (MHCE) remains suboptimal.

OBJECTIVE

To identify specific organisational models that could address the mental healthcare needs of the elderly in community and primary care.

METHOD

A multi-modal approach, consisting of a literature review, an online survey of Belgian professional stakeholders, and an international comparison. The outcomes of this three-step study process were aggregated.

RESULTS

Two general and four operational strategies for organising MHCE were identified as well as barriers and incentives to MHCE in the community and primary care. About half of survey respondents perceived the current MHCE in Belgium not to meet quality criteria as described in the literature and proposed points of improvement. The transversal international comparison revealed interesting approaches for MHCE. Recommendations for the future were formulated.

CONCLUSION

MHCE requires a specific, low-threshold, holistic, and transdisciplinary approach. Specific strategies with emphasis on collaborative care should be applied to meet the needs of older adults with mental problems. General practitioners (GPs) can play a central role in community-oriented MHCE but should be supported by specialised healthcare providers (including old-age psychiatrists and geriatricians). Stigma and wrong beliefs, regarding the elderly population, should be tackled by means of campaigns.

Self-Paced Cycling Improves Cognition on Institutionalized Older Adults Without Known Cognitive Impairment: A 15-Month Randomized Controlled Trial

This study aimed at identifying the effects of self-paced cycling on the cognitive and functional status and fall risk on institutionalized older adults without cognitive impairment. A total of 39 individuals were randomly assigned to an exercise group or to a control group. The exercise group participants cycled at their self-selected intensity at least for 15 min daily during 15 months. The control group participants performed recreational activities. The Mini-Mental State Examination, Fuld object memory evaluation, and symbol digit modality test were used for cognitive assessments. The Katz index, the timed “Up & Go” test, and the World Health Organization questionnaire were used to assess functional independence, mobility, and fall risk. Significant improvements were observed in the exercise group for global cognition and attention, visual scanning, and processing speed. Long-term self-paced cycling training seems to have a protective effect on cognitive status and attention, visual scanning, and processing speed in older institutionalized individuals.

Prevention of anxiety and depression in Chinese: a randomized clinical trial testing the effectiveness of a stepped care program in primary care

BACKGROUND

Despite empirical evidence demonstrating the effectiveness of collaborative stepped care program (SCP) in Western countries, such programs have not been evaluated in the east, which has a different services system structure and cultural nuances in seeking help for mental illness. Furthermore, only a few studies have used SCP for depression and anxiety prevention. We conducted a trial to test its effectiveness in preventing major depressive disorder and generalized anxiety disorder among primary care patients with subthreshold depression and/or anxiety in Hong Kong.

METHODS

Subthreshold depression and/or anxiety patients were randomized into the SCP group (n=121) or care as usual (CAU) group (n=119). The SCP included watchful waiting, telephone counseling, problem solving therapy, and family doctor treatment within one year. The primary outcome was the onset of major depressive disorder or generalized anxiety disorder in 15 months. The secondary outcomes were depressive and anxiety symptoms, quality of life and time absent from work due to any illness.

RESULTS

Survival analysis showed no differences between the SCP and CAU groups (the cumulative probability of onset at 15 month was 23.1% in the SCP group and 20.5% in the CAU group; Hazard Ratio=1.62; 95% Confidence Interval: 0.82-3.18; p=0.16). No significant differences were found in secondary outcomes.

LIMITATIONS

Sample size might not have been large enough.

CONCLUSIONS

SCP did not show beneficial effect on depression/anxiety prevention compared with CAU in Hong Kong primary care. As a large majority of patients improved overtime without any intervention, we are not able to exclude the possibility that the intervention might be effective. Future studies would need to have a larger sample size and conduct on patients with more severe symptoms or perform a second screening.