Mental Health and Mental Illness: Interventions to Reduce Depression Among Older Adults Clinic-Based Depression Care Management

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends depression care management in primary care clinics for older adults with major depression or chronic low levels of depression (dysthymia) on the basis of sufficient evidence of effectiveness in improving short-term depression outcomes.

The CPSTF has related findings for the following interventions to reduce depression among older adults:

Home-based depression care management (recommended)
Community-based exercise interventions (insufficient evidence)

Intervention

Clinic-based depression care management involves:

Active screening for depression
Measurement-based outcomes
Trained depression care managers providing case management, and
Primary care provider and patient education, antidepressant treatment and/or psychotherapy, and a supervising psychiatrist

An older adult is defined as 60 years of age or older.

CPSTF Finding and Rationale Statement

Read the CPSTF finding .

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 2 studies (search period 1967 – October 2005). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and experts in research, practice, and policy from the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.

Summary of Results

Two studies evaluated the effect of clinic-based depression care management.

Unutzer et al (2002) reported a 45% response rate and a 25% remission rate for subjects with major depression or dysthymia.
Bruce et al (2004) found a 55% response rate and a 36% remission for subjects with major depression after a similar time period; no statistically significant improvement was found for subjects with minor depression.

Summary of Economic Evidence

Unutzer et al (2002) estimated the cost of implementing clinic-based depression care management at $580/person (this data does not factor in cost savings measures, such as reductions in health care utilization).

Applicability

The evidence should be broadly applicable to primary care clinics across the United States including various clinic size, healthcare systems, urban, suburban and rural settings, and participants ranging in age, health status, gender race/ethnicity, education level, and living alone status.