The feasibility and effectiveness of brief interventions to prevent depression in older subjects: a systematic review.

Abstract

To explore the feasibility and effectiveness of brief interventions to prevent depression in older subjects. MEDLINE, PsycINFO and HealthStar were searched for potentially relevant articles published from January 1966 to June 2003, January 1974 to June 2003 and January 1975 to June 2003, respectively. The bibliographies of relevant articles were searched for additional references. Ten studies met the following five inclusion criteria: original research, subjects mean age 50 years or more, controlled trial of a brief (<12 weeks) intervention to prevent depression, determination of depression status 12 months or more after enrolment, use of an acceptable definition of depression. The validity of studies was assessed according to six criteria. To examine feasibility we tabulated study enrolment, completion and compliance rates. To examine effectiveness we tabulated differences in depression symptom outcome scores between intervention and control groups or, when possible, absolute (ARR) and relative (RRR) risk reductions for depression. Only two of the ten trials met all of the validity criteria. Study enrolment rates were 21 to 100% (median 72.5%); study completion rates were 46% to 100% (median 85%); compliance rates were 29% to 100% (median 87%). Five of the ten trials had positive results: in two trials there were statistically significant differences in depression symptom outcome scores favoring the intervention group; in three trials ARRs were 2.3% to 45% (median 17%); RRRs were 45% to 71% (median 61%). Some types of brief interventions appear to have the potential to prevent depression in older subjects. Despite the methodologic limitations of the trials and this systematic review, these findings may guide efforts to develop and evaluate brief interventions to prevent depression in this population.