Prevention and Treatment of Depression in Older People: A Population-Based Study

Abstract

Prevention of depressive disorders in the elderly: in two Basic Health Units in the low income region of Butanta, in Sao Paulo city, 2,700 individuals 60 years and older, will be screened for the presence of depressive symptoms and/or clinically significant anxiety (CES-D). The subjects selected will be assessed to identify those with sub-threshold symptom levels (of depression and/or anxiety, but not meet criteria for depressive disorders and/or anxiety. Participants will be invited to participate in a randomized clinical trial with 3 arms of intervention: 2 different stepped-care programs step by step (n = 90 subjects each) or usual care (n = 90). Stepped-care participants will sequentially receive: 1) watchful waiting approach, followed by cognitive-behavior based-bibliotherapy, cognitive-behavior based-problem solving, and referral to drug treatment in the primary care units, if necessary; 2) watchful waiting approach, followed by a 24-week physical activity home-based program, and referral to drug treatment in the primary care units, if necessary. The primary outcome measure will assess the cumulative incidence of major depressive disorder, or disorder of anxiety, after 12 months, using a structured psychiatric interview (MINI). Predictors of response to treatment of major depressive disorder: in a naturalistic clinical trial, 120 elderly patients with major depressive disorder will be followed for 18 months to assess baseline characteristics (psychopathology, personality traits, cognitive performance, neuroimaging findings and genotyping). Patients will undergo a treatment algorithm for depression in the elderly, and will be evaluated every 3 months up to 18 months. (AU)