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A systematic review of community-based health interventions on depression for older adults with heart disease
- Authors:
- KANG-YI Christina D., GELLIS Zvi D.
- Journal article citation:
- Aging and Mental Health, 14(1), January 2010, pp.1-19.
- Publisher:
- Taylor and Francis
This systematic review examines the effectiveness of community-based heart-health interventions on depression outcomes among homebound elderly (64 years and older) with heart disease. People with heart disease who are depressed have an increased risk of death after a heart attack, and therefore treatment for depression in conjunction with heart disease may help patients to manage both diseases. A comprehensive literature search and meta-analysis was performed to evaluate randomised controlled trials examining outpatient or home-based interventions. The methodological quality was assessed by standard criteria developed by the Cochrane Collaborative Initiative. This identified 15 studies which met the inclusion criteria and all measured depression outcomes. The studies differed in scope and methodological rigor and sample sizes varied widely. Problems in treatment fidelity and masking of group assignment were noted. Great variability was found in depression outcomes due to the differences in methodology and intervention. Five studies reported significant treatment effect on depression; three of those employed home-based interventions and two were outpatient-clinic interventions. Ten studies were included in the meta-analysis and the mean weighted effect size was 0.11, with 6 studies showing a positive effect size. The article concludes that mixed evidence for community-based heart disease interventions on depression outcomes was found. Future intervention studies should conduct more rigorous trials over longer time periods and consider using the Consolidated Standards of Reporting Trials (CONSORT).
Randomised controlled trial of problem-solving therapy for minor depression in home care
- Authors:
- GELLIS Zvi D., et al
- Journal article citation:
- Research on Social Work Practice, 18(6), November 2008, pp.596-606.
- Publisher:
- Sage
Data are presented from a pilot research program initiated to develop, refine, and test the outcomes of problem-solving therapy that targets the needs of older adults with minor depression in home care settings. A pilot randomized clinical trial compares the impact of problem-solving therapy for home care to treatment as usual in a sample of older, medically ill home care patients. Compared with 32 older home care participants randomized to the treatment as usual condition, 30 older home care participants in an intervention condition received brief problem-solving therapy. Outcome data suggest significant improvements in depression symptomatology and problem-solving abilities after problem-solving therapy for home care, relative to treatment as usual. The experimental group was also more satisfied with treatment as compared to the control condition. Authors discuss results in terms of the "real-world" social work applicability of this psychosocial treatment for late-life depression.
Social work practitioner knowledge and assessment of late-life depression
- Author:
- GELLIS Zvi D.
- Journal article citation:
- Journal of Gerontological Social Work, 53(6), August 2010, pp.495-511.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
A random sample of 168 social work practitioners currently registered with the National Association of Social Workers (NASW) and working with adults in New York State completed surveys to examine levels of knowledge and self-efficacy (confidence) in evaluation of depression in late life. The survey instrument consisted of socio-demographic and job-related questions, knowledge about late-life depression, confidence ratings in clinical practice, rankings of common clinical problems, and knowledge about ageing issues. Relationships among knowledge on aging, job-related variables, and predictors of knowledge of geriatric depression were examined. All participants were women and had gained MSW degrees, participants were aged between 33 and 62 years. Participants had worked in the social work field for a mean of 12.3 years and 63% reported that they had weekly contact with older adults. The most common clinical problem seen by the social work sample was depression (73.3%). Overall the participants scored relatively well regarding knowledge of late-life depression (79% correct). Participants scored at the lower end on knowledge about ageing, and experienced great difficulty on the items pertaining to evaluation of suicide risk in older adults. Implications of the findings for social work practice are discussed.
Assessment of a brief CES-D measure for depression in homebound medically ill older adults
- Author:
- GELLIS Zvi D.
- Journal article citation:
- Journal of Gerontological Social Work, 53(4), May 2010, pp.289-303.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Research shows that late life depression is one of the most common mental disorders in older people, and is often under-diagnosed and under treated. These depressive symptoms are especially frequent amongst medically ill homebound older people and are associated with significant functional decline, lower quality of life, and increased health care usage. This study was designed to determine the validity of a brief depression measure (CES-D) and examine the nature of depressive symptoms reported by the older sample. Using confirmatory factor and rating scale analysis, the factor structure of responses in a cross-sectional home care sample of 618 older adults was examined with a further analysis of item responses from identified urban and rural subsamples, from New York, United States. Results indicated that Radloff's (1977) four-factor depression model fit the data well. However, findings also showed that some symptom items were expressed differently. The author concludes that this presents an opportunity to understand the unique clinical aspects of depression in homebound older adults.