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Brief interventions to prevent depression in older subjects: a systematic review of feasibility and effectiveness
- Author:
- COLE Martin G.
- Journal article citation:
- American Journal of Geriatric Psychiatry, 16(6), June 2008, pp.435-443.
- Publisher:
- Lippincott Williams and Wilkins
This systematic review proposed to explore the feasibility and effectiveness of brief interventions to prevent depression in older subjects. Computer databases were searched for potentially relevant articles published up until August, 2007. The bibliographies of relevant articles were searched for additional references and all the retrieved articles were screened to meet the following five inclusion criteria: original research, subjects mean age 40 years or more, controlled trial of a brief (<12 weeks) intervention to prevent depression, determination of depression status 6 months or more after enrolment, and use of an acceptable definition of depression. To examine feasibility, study enrolment, completion, and compliance rates were tabulated. To examine effectiveness, differences in depression symptom outcome scores or, when possible, absolute risk reductions (ARR) and relative risk reductions (RRR) for depression were tabulated. Fourteen trials were located. All were trials of brief psychosocial interventions. Many had one or more methodological limitations. Eight trials had positive results. In three trials there were significant differences in depression symptom outcome scores favouring the intervention group. Guidelines to improve the quality of future trials are proposed.
The 6 and 12 month outcomes of older medical inpatients who recover from delirium
- Authors:
- COLE Martin G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(3), March 2008, pp.301-307.
- Publisher:
- Wiley
The aim was to compare the 6 and 12 month outcomes of patients who recovered from delirium by 8 weeks with those who did not have an index episode. Older medical inpatients were assessed for delirium using the Confusion Assessment Method. All patients with delirium and a sample of patients without delirium were enrolled. Recovery from delirium at 8 weeks was determined using the Delirium Index and an algorithm based on DSM-III-R criteria. The primary composite outcome was cognitive or functional decline, institutional residence or death at 6 and 12 months. The authors fitted two logistic regression models to predict outcome odds ratio (OR) of delirium-recovered vs no delirium groups, adjusting for co-morbidity, severity of physical illness and demographic variables. In secondary analyses, each component of the primary outcome was examined separately. Of 361 patients enrolled, 59 died, 33 withdrew and one was lost to follow-up before 8 weeks. Of 268 patients assessed at 8 weeks, 115 and 95 were in delirium-recovered and no delirium groups, respectively. The 6 month OR for the primary composite outcome was 0.89 (95% CI 0.46, 1.70); the 12 month OR was 1.5 (95% CI 0.77, 2.90). Secondary analyses revealed a clinically important increase in mortality at 6 and 12 months. Among patients who survived, there were no significant differences in cognition, function or institutional status between delirium-recovered and no delirium groups at 6 and 12 months. If replicated, these findings have potentially important implications for clinical practice and research.