Mental Health and Mental Illness: Interventions to Reduce Depression Among Older Adults Clinic-Based Depression Care Management
Findings and Recommendations
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)
The full CPSTF Finding and Rationale Statement and supporting documents for Improving Mental Health and Addressing Mental Illness: Interventions to Reduce Depression among Older Adults, Clinic-Based Depression Care Management are available in The Community Guide Collection on CDC Stacks.
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.
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of 2 studies (search period 1967 — October 2005).
Study Characteristics
Not available because the CPSTF finding is based on a previously published systematic review (Frederick et al., 2007). Please refer to the article for more information.
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, sex, race/ethnicity, education level, and living alone status.
Evidence Gaps
Not available because the CPSTF finding is based on a previously published systematic review (Frederick et al., 2007). Please refer to the article for more information.
Implementation Considerations and Resources
Not available because the CPSTF finding is based on a previously published systematic review (Frederick et al., 2007). Please refer to the article for more information.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.