Interventions to Reduce Depression Among Older Adults: Clinic-Based Depression Care Management

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.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force 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.

Results of the Systematic Reviews

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

• Unutzer et al (2004) reported a 45% response rate and a 25% remission rate for subjects with major depression or dysthymia.
• Bruce et al (2002) 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.

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.

Unutzer et al (2004) 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).

* References for articles mentioned in this section can be found in the original paper cited below (Frederick et al. 2007).

These results were based on a systematic review of all available studies that met review criteria 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.

Publications

Frederick JT, Steinman LE, Prohaska T, et al. Community-based treatment of late life depression—an expert panel informed literature review. Am J Prev Med 2007;33(3):222–49.

Steinman LE, Frederick JT, Prohaska T, et al. Recommendations for treating depression in community-based older adults. Am J Prev Med 2007:33(3):175-81.

Snowden M, Steinman L, Frederick J. Treating depression in older adults: challenges to implementing the recommendations of an expert panel. Prev Chronic Dis 2008;5(1):A26.

More Community Guide publications about Mental Health & Mental Illness

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Guide to Community Preventive Services. Interventions to reduce depression among older adults: clinic-based depression care management. www.thecommunityguide.org/mentalhealth/depression-clinic.html. Last updated: MM/DD/YYYY.

Review completed: February 2008