Lifestyle Interventions Can Prevent Major Depression in Some Older Adults
Discussions with a dietary coach to learn about healthy eating were as effective as meeting with a counselor for problem-solving or “talk” therapy in preventing major depression among older black and white adults with mild symptoms of the mood disorder, according to researchers at the University of Pittsburgh and the University of Maryland. Their findings were published online recently in Psychiatric Services.
Depression is common, and treatments often don’t completely resolve the disability that attends the illness, said senior author Charles F. Reynolds III, UPMC Endowed Professor of Geriatric Psychiatry, Pitt School of Medicine. Sadness, fatigue, and disinterest in activities that used to bring pleasure can leave patients isolated and unable to care for themselves.
“That’s why we’re very interested in finding ways to prevent the disease in those we know are particularly vulnerable,” he said. “Avoiding episodes of major depression can help people stay happy and engaged in their communities, as well as reduce health care costs.”
The team assessed whether problem-solving therapy for primary care, or PST-PC, could prevent elderly adults with mild symptoms of depression from developing full-blown disease. PST-PC is a scientifically proven approach delivered by non-mental-health professionals to help patients resolve difficulties and improve coping skills and confidence. This group of elderly adults was compared to participants who underwent a program of dietary coaching at a similar visit interval for the same number of hours.
Researchers used innovative strategies to recruit and retain African American study participants, building upon a culturally tailored approach developed by Sandra Quinn and Stephen Thomas, co-investigators from the University of Maryland Center for Health Equity.
“Because racial minorities are at greater risk for depression, in part due to socioeconomic disadvantages, lower educational attainment, and a greater likelihood of other medical problems, we established a foundation of trust working through churches and community-based organizations in black communities,” said Quinn. Of the 244 participants, 90, or more than one-third, were African American.
According to Reynolds, “Previous studies we and others have done indicate about 25 percent of people in later life who are mildly depressed become seriously depressed in the next one to two years.” In this study, the researchers found about 9 percent of the people in each intervention arm went on to experience an episode of major depression, and they all had a similar reduction in depressive symptoms over the two-year study period. Also, both approaches were equally successful among black and white participants.
“This project tells us that interventions in which people actively engage in managing their own life problems, such as financial or health issues, tend to have a positive effect on well-being and a protective effect against the onset of depression.”
“We suspect we had a higher than usual proportion of black participants because community leaders championed the project, no medication was prescribed, and treatment could be delivered at home or at other non-clinical settings,” Thomas said. “Lifestyle interventions, such as dietary coaching, may be more culturally appropriate and acceptable in racial-ethnic minority communities.”
In a new project, the researchers will examine whether the therapy for primary care can be effectively administered by lay health counselors in low- and middle-income countries such as India.
Additional Pitt co-authors of the paper include Jennifer Q. Morse, Steven Albert, Mary Amanda Dew, Amy Begley, Meryl A. Butters, Jordan F. Karp, Ariel Gildengers, Jacqueline A. Stack, John Kasckow, and Mark D. Miller.
The study was funded by the National Institute of Mental Health, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, the University of Pittsburgh Medical Center Endowment in Geriatric Psychiatry, and the Commonwealth of Pennsylvania.
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On the Freedom Road
Follow a group of Pitt students on the Returning to the Roots of Civil Rights bus tour, a nine-day, 2,300-mile journey crisscrossing five states.
Day 1: The Awakening
Day 2: Deep Impressions
Day 3: Music, Montgomery, and More
Day 4: Looking Back, Looking Forward
Day 5: Learning to Remember
Day 6: The Mountaintop
Day 7: Slavery and Beyond
Day 8: Lessons to Bring Home
Day 9: Final Lessons