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Preventing Depression in Later Life: Translation From Concept to Experimental Design and Implementation

From the Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, University of Pittsburgh School of Medicine, Pittsburgh, PA (RS, MDM, JAS, JK, CB, CFR); John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA (CFR); VA Pittsburgh Health Care System, and Western Psychiatric Institute and Clinic, Pittsburgh, PA (JK); and Center for Minority Health, and Research Center of Excellence in Minority Health Disparities, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (AFF, SBT).

Objective: The authors detail the public health need for depression prevention research and the decisions made in designing an experiment testing problem solving therapy as "indicated" preventive intervention for high-risk older adults with subsyndromal depression. Special attention is given to the recruitment of African Americans because of well-documented inequalities in mental health services and depression treatment outcomes between races.

Methods: A total of 306 subjects (half white, half African American) with scores of 16 or higher on the Center for Epidemiological Studies of Depression Scale, but with no history of major depressive disorder in the past 12 months, are being recruited and randomly assigned to either problem solving therapy-primary care or to a dietary education control condition. Time to, and rate of, incident episodes of major depressive disorder are to be modeled using survival analysis. Level of depressive symptoms will be analyzed via a mixed models approach.

Results: Twenty-two subjects have been recruited into the study, and to date eight have completed the randomly assigned intervention and postintervention assessment. Four of 22 have exited after developing major depressive episodes. None have complained about study procedures or demands. Implementation in a variety of community settings is going well.

Conclusion: The data collected to date support the feasibility of translating from epidemiology to RCT design and implementation of empirical depression prevention research in later life.

Key Words: Depression prevention • indicated preventive intervention • elderly • African American • translation

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				C. F. Reynolds III Preventing Depression in Old Age: It's Time Am J Geriatr Psychiatry, June 1, 2008; 16(6): 433 - 434. [Full Text] [PDF]