Early Intervention to Preempt Major Depression Among Older Black and White Adults

A randomized trial found that older adults with subsyndromal depression who received problem-solving therapy for primary care (PST-PC) avoided developing major depression for two years. But in an unexpected finding, so did a comparison group of patients who received only dietary counseling. Even though dietary counseling did not address depression per se, the authors speculated that it provided some of the same active features as PST-PC, including homework assignments and monitoring of adherence. Both interventions are suitable for delivery by lay health counselors, making use in primary care settings easier. ObjectiveThe study objective was to assess the efficacy of problem-solving therapy for primary care (PST-PC) for preventing episodes of major depression and mitigating depressive symptoms of older black and white adults. The comparison group received dietary coaching.MethodsA total of 247 participants (90 blacks, 154 whites, and three Asians) with subsyndromal depressive symptoms were recruited into a randomized depression prevention trial that compared effects of individually delivered PST-PC and dietary coaching on time to major depressive episode and level of depressive symptoms (Beck Depression Inventory) over two years. Cumulative intervention time averaged 5.5−6.0 hours in each study arm.ResultsThe two groups did not differ significantly in time to major depressive episodes, and incidence of such episodes was low (blacks, N=8, 9%; whites, N=13, 8%), compared with published rates of 20%–25% over one year among persons with subsyndromal symptoms and receiving care as usual. Participants also showed a mean decrease of 4 points in depressive symptoms, sustained over two years. Despite greater burden of depression risk factors among blacks, no significant differences from whites were found in the primary outcome.ConclusionsBoth PST-PC and dietary coaching are potentially effective in protecting older black and white adults with subsyndromal depressive symptoms from developing episodes of major depression over two years. Absent a control for concurrent usual care, this conclusion is preliminary. If confirmed, both interventions hold promise as scalable, safe, nonstigmatizing interventions for delaying or preventing episodes of major depression in the nation’s increasingly diverse older population.