NEW ORLEANS – Both problem-solving and lifestyle interventions significantly reduced the incidence of major depression among black and white community-living elders who had some mild symptoms of the disorder.
By 2 years, both interventions conferred a 4-point decrease in the Beck Depression Inventory (BDI) score, with whites and blacks experiencing the same benefit, Dr. Charles F. Reynolds III said at the annual meeting of the American Association for Geriatric Psychiatry.
Dr. Charles F. Reynolds III
“Perhaps not surprisingly, improving scores in [problem solving] predicted lower depression scores, and falling depression scores predicted better scores in [problem solving],” said Dr. Reynolds, the UPMC Endowed Professor in Geriatric Psychiatry at the University of Pittsburgh. “This suggests a bidirectional effect. Better problem-solving leads to improvement in depression, and improvement in depression leads to better problem solving.”
Dr. Reynolds and his colleagues conducted a 2-year study of a problem-solving intervention and a dietary intervention in a cohort of elderly subjects with subsyndromal depressive symptoms. The primary endpoint was a three-way comparison: problem-solving vs. dietary intervention overall, black vs. white response overall, and overall response vs. response in comparable groups undergoing usual care.
Their study comprised 154 white participants and 90 black participants. “Getting black participants into clinical trials has always been challenging for us,” he said. “Typically, we get about 10%-12% rates. This cohort approached 40%, which I think reflected several things,” the most crucial of which was recruitment technique.
“We identified ‘community champions’ – people who had leadership positions in the black community, especially in the religious communities. They gave us the imprimatur of their approval to participate. We also recruited through churches and community centers, and saw patients there. We didn’t ask them to come into the lab,” said Dr. Reynolds, also professor of neurology, behavioral and community health sciences, and clinical and translational science at the university.
All subjects also received financial compensation for being in the study – a total of $450 each over the full 2-year period.
The subjects were a mean of 65 years old. Scores on the Hamilton Depression Rating Scale (HAM-D) and the BDI indicated mild depression in each group.
The black participants had more traditional risk factors for depression. Fewer were married (25% vs. 88% of whites), and fewer were employed (27% vs. 71%). Median household income was $31,000 vs. $58,000. Blacks had fewer years of education as well (13 vs. 15). They also had poorer overall health and more medical comorbidities. About 60% of each group had a body mass index greater than 30 kg/m2 – the prime factor that motivated choosing diet as the comparator therapy.
Problem-solving therapy was talk based, with the subject and the clinician collaborating to identify problems and focus on solving them with a structured approach. It also included assessments of the subjects’ general approach to problems. Dietary therapy focused on improving healthful eating through better shopping, cooking, and eating. The cumulative “face time” between subjects and clinicians was just 6 hours over the 2 years – a “remarkably short period,” Dr. Reynolds noted, with short booster sessions conducted every 6 months.
At the end of 2 years, both interventions conferred a 13% lower risk of major depression, corresponding to an overall incidence of about 8%. Blacks and whites achieved comparable results. Archival data suggest a 20%-25% rate of major depression when elderly adults with subsyndromal symptoms receive usual care.
Both groups achieved a 4-point decrease in the BDI score, which was evidenced by 6 months and sustained over the duration of the study.
Dr. Reynolds cautioned against overinterpreting the results, however.
“In the absence of a direct comparator of usual care, we need to consider these results promising but still preliminary.”
He said he had no relevant financial disclosures.
msullivan@frontlinemedcom.com
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