Depression in Long-Term Care: Contrasting a Disease Model with Attention to Environmental Impact.

Abstract

The preceding review of depression in long-term care (LTC settings recognizes the prevalence of depression in LTC, addresses problems in assessment of depression, and examines empirical literature on the effectiveness of psychotherapy for depression. This commentary expands on the preceding review by focusing on a theoretical understanding of depression and how that understanding can inform treatment recommendations. The basic argument presented is that psychologists could best serve older adults in LTC settings by extending beyond traditional approaches to treatment of individuals who are depressed; psychologists can become good observers of the relationship of environmental factors in LTC to the internal emotional experience of depression, and then help to serve as change agents by collaborating in designing and implementing change in LTC environments. Such a radical shift could improve the quality of life for LTC residents. It also offers the possibility of defining theoretical linkages among external environmental variables, cognitive understanding of them, and emotional experience that could inform depression theory generally.