Steinman Lesley E, Frederick John T, Prohaska Thomas, Satariano William A, Dornberg-Lee Sharon, Fisher Rita, Graub Pearl Beth, Leith Katherine, Presby Kay, Sharkey Joseph, Snyder Susan, Turner David, Wilson Nancy, Yagoda Lisa, Unutzer Jurgen, Snowden Mark
Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA.
Am J Prev Med. 2007 Sep;33(3):175-81. doi: 10.1016/j.amepre.2007.04.034.
To present recommendations for community-based treatment of late-life depression to public health and aging networks.
An expert panel of mental health and public health researchers and community-based practitioners in aging was convened in April 2006 to form consensus-based recommendations. When making recommendations, panelists considered feasibility and appropriateness for community-based delivery, as well as strength of evidence on program effectiveness from a systematic literature review of articles published through 2005.
The expert panel strongly recommended depression care management-modeled interventions delivered at home or at primary care clinics. The panel recommended individual cognitive behavioral therapy. Interventions not recommended as primary treatments for late-life depression included education and skills training, comprehensive geriatric health evaluation programs, exercise, and physical rehabilitation/occupational therapy. There was insufficient evidence for making recommendations for several intervention categories, including group psychotherapy and psychotherapies other than cognitive behavioral therapy.
This interdisciplinary expert panel determined that recommended interventions should be disseminated throughout the public health and aging networks, while acknowledging the challenges and obstacles involved. Interventions that were not recommended or had insufficient evidence often did not treat depression primarily and/or did not include a clinically depressed sample while attempting to establish efficacy. These interventions may provide other benefits, but should not be presumed to effectively treat depression by themselves. Panelists also identified primary prevention of depression as a much under-studied area. These findings should aid individual clinicians as well as public health decision makers in the delivery of population-based mental health services in diverse community settings.
向公共卫生和老龄网络提供关于社区治疗老年期抑郁症的建议。
2006年4月召集了一个由心理健康和公共卫生研究人员以及老龄领域社区从业者组成的专家小组，以形成基于共识的建议。在提出建议时，小组成员考虑了社区提供服务的可行性和适宜性，以及通过对截至2005年发表的文章进行系统文献综述得出的项目有效性证据的力度。
专家小组强烈推荐以家庭或初级保健诊所为基础实施的抑郁症护理管理模式干预措施。小组推荐个体认知行为疗法。不建议作为老年期抑郁症主要治疗方法的干预措施包括教育和技能培训、综合老年健康评估项目、运动以及身体康复/职业疗法。对于包括团体心理治疗和认知行为疗法以外的其他心理治疗在内的几个干预类别，缺乏足够证据来提出建议。
这个跨学科专家小组确定，应在公共卫生和老龄网络中推广推荐的干预措施，同时承认其中涉及的挑战和障碍。未被推荐或证据不足的干预措施通常并非主要针对抑郁症进行治疗，和/或在试图确定疗效时未纳入临床抑郁症样本。这些干预措施可能有其他益处，但不应假定它们本身能有效治疗抑郁症。小组成员还指出抑郁症的一级预防是一个研究严重不足的领域。这些研究结果应有助于个体临床医生以及公共卫生决策者在不同社区环境中提供基于人群的心理健康服务。
