Author
YOHANNES Abebaw Mengitsu; CATON Sue;
Management of depression in older people with osteoarthritis: a systematic review.
Journal citation/publication details
Aging and Mental Health, 14(6), August 2010, pp.637-651.
Summary
The majority of the 14 intervention studies included in the review showed some improvement in depressive symptoms in the short term. The evidence is limited by the wide range of interventions and the heterogeneity of the studies. Also, depression was not a primary outcome in most of the studies.
Context
Depression and osteoarthritis (OA) are often seen together, especially in older people. A number of risk factors have been identified, many of which are modifiable. The aim of this review was to examine the impact of ‘education programmes, cognitive behavioural therapy (CBT), exercise and depression care on depressive symptoms in older people with OA’ in order to inform evidence-based practice.
Methods
What sources were searched?
The following databases were searched for articles published between January 1990 and July 2009: Medline, CINAHL, PsycINFO, Pubmed, Web of Knowledge, and Scopus. The reference lists of included studies and ‘relevant journals and conference reports’ were hand searched.
What search terms/strategies were used?
The keywords used were: ‘depression’, ‘osteoarthritis’ ‘intervention’, ‘exercise’, ‘cognitive behavioural therapy’’, ‘CBT’, and ‘antidepressants’. Specific search details are not included.
What criteria were used to decide on which studies to include?
Studies examining the effect of education programmes, CBT, exercise or depression care on OA and depression were eligible for inclusion. Studies on arthritis were included if the majority of participants were diagnosed with OA. Only articles published in English were included.
Who decided on their relevance and quality?
Screening was carried out independently by each of the authors and the results were compared. There is no indication that the studies were quality assessed.
How many studies were included and where were they from?
A total of 1,170 studies were initially identified 14 of which were included in the review. There is no indication of the settings of the included studies.
How were the study findings combined?
The results are presented as a narrative synthesis for each type of intervention, and details of the studies are briefly summarised in Table 1. The clinical significance of the results of each study were classified as ‘recovered’, ‘improved’, ‘unchanged’, or ‘deteriorated’ according to the criteria of Jacobson, Follette, and Revenstorf, 1984.
Findings of the review
Seven of the studies used an exercise intervention, three a patient education programme, two examined CBT and two focused on depression care and/or the use of antidepressants. A range of depression outcome measures and study designs were employed, and the number of participants ranged from 14 to 1,001.
Overall, 11 of the 14 studies showed some short-term improvement in depressive symptoms. Exercise programmes varied greatly and included group activities such as Tai Chi and aquatic exercise, and home-based strengthening exercises. Depressive symptoms were significantly reduced in four of the seven exercise intervention studies. Patient education programmes were beneficial in reducing depressive symptoms in the short-term. None of the CBT interventions showed clinically significant change in depression post-intervention. Both studies of depression care, one of which was a pilot study, were effective in reducing depression scores.
Authors' conclusions
‘The success of the majority of the interventions that have been examined here in reducing depressive symptoms in people with OA present encouraging evidence for the provision of such interventions for older adults with OA, with comorbid depression.’
Implications for policy or practice
None are discussed.