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Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis

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  • Floor Holvast
  • Btissame Massoudi
  • Richard C Oude Voshaar
  • Peter F M Verhaak

Abstract

Background: Late-life depression is most often treated in primary care, and it usually coincides with chronic somatic diseases. Given that antidepressants contribute to polypharmacy in these patients, and potentially to interactions with other drugs, non-pharmacological treatments are essential. In this systematic review and meta-analysis, we aimed to present an overview of the non-pharmacological treatments available in primary care for late-life depression. Method: The databases of PubMed, PsychINFO, and the Cochrane Central Register of Controlled Trials were systematically searched in January 2017 with combinations of MeSH-terms and free text words for “general practice,” “older adults,” “depression,” and “non-pharmacological treatment”. All studies with empirical data concerning adults aged 60 years or older were included, and the results were stratified by primary care, and community setting. We narratively reviewed the results and performed a meta-analysis on cognitive behavioral therapy in the primary care setting. Results: We included 11 studies conducted in primary care, which covered the following five treatment modalities: cognitive behavioral therapy, exercise, problem-solving therapy, behavioral activation, and bright-light therapy. Overall, the meta-analysis showed a small effect for cognitive behavioral therapy, with one study also showing that bright-light therapy was effective. Another 18 studies, which evaluated potential non-pharmacological interventions in the community suitable for implementation, indicated that bibliotherapy, life-review, problem-solving therapy, and cognitive behavioral therapy were effective at short-term follow-up. Discussion: We conclude that the effects of several treatments are promising, but need to be replicated before they can be implemented more widely in primary care. Although more treatment modalities were effective in a community setting, more research is needed to investigate whether these treatments are also applicable in primary care. Trial registration: PROSPERO CRD42016038442.

Suggested Citation

  • Floor Holvast & Btissame Massoudi & Richard C Oude Voshaar & Peter F M Verhaak, 2017. "Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-20, September.
  • Handle: RePEc:plo:pone00:0184666
    DOI: 10.1371/journal.pone.0184666
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    References listed on IDEAS

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    1. Melissa M. Garrido & Robert L. Kane & Merrie Kaas & Rosalie A. Kane, 2009. "Perceived Need for Mental Health Care Among Community-Dwelling Older Adults," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 64(6), pages 704-712.
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    Cited by:

    1. Yawei Guo & Jingjie Sun & Simeng Hu & Stephen Nicholas & Jian Wang, 2019. "Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China," IJERPH, MDPI, vol. 16(19), pages 1-11, September.
    2. Iris van Venrooij & Jan Spijker & Gerben J. Westerhof & Ruslan Leontjevas & Debby L. Gerritsen, 2019. "Applying Intervention Mapping to Improve the Applicability of Precious Memories, an Intervention for Depressive Symptoms in Nursing Home Residents," IJERPH, MDPI, vol. 16(24), pages 1-15, December.
    3. Tomasz Zaprutko & Robert Göder & Krzysztof Kus & Wiktor Pałys & Filip Rybakowski & Elżbieta Nowakowska, 2018. "The economic burden of inpatient care of depression in Poznan (Poland) and Kiel (Germany) in 2016," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-14, June.
    4. Páll Biering, 2019. "Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care," European Journal of Ageing, Springer, vol. 16(2), pages 215-225, June.

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