Depression interventions provided by lay counselors are effective in preventing onset of major depressive disorder in older adults presenting subsyndromal symptoms and may be scalable for treating low- and middle-income populations, according to study results published in JAMA Psychiatry,
The investigators of this parallel-group randomized study sought to evaluate whether an intervention called depression in later life (DIL) provided by lay counselors in the primary care or community setting is effective for preventing major depressive episodes in older adults.
The study sample included 181 adults aged 60 years or older with subsyndromal depressive symptoms recruited from primary care clinics in both rural and urban areas of Goa, India. Participants were randomly assigned to the intervention arm (n=91) or care as usual (n=90).
Lay counselors provided DIL intervention, which is grounded in problem-solving therapy and brief behavioral treatment for insomnia and includes education for self-management of common chronic disorders such as diabetes and help in accessing government-sponsored medical and social programs. The primary study outcome was development of incident episodes of major depressive disorder. The study investigators further assessed the participants’ change in symptoms, functional status, cognitive functioning, blood pressure, and body mass index over 12 months.
The study results showed that incidence of major depressive episodes were lower in the intervention arm (4.40%) vs the care as usual group (14.44%). According to the 12-month Kaplan-Meier estimates, the proportion of depression-free participants in the intervention group was 95.1% (95% CI, 90.5%-99.9%) while the care as usual group was 87.4% (95% CI, 80.4%-95.1%). The 12-month mean incidence of depressive symptoms were also less. No changes were observed in functional status or cognition scores; however, the intervention group was significantly associated with lower systolic — but not diastolic — blood pressure and with a greater change in body mass index.
Limitations to the study were the exclusion of patients with mild dementia or cognitive impairment and a short follow-up period, which limited evidence of the durability of the intervention effect. Furthermore, data on biomarkers identifying risk of depression were unavailable and may have been used to target high-risk patients for the intervention.
Incidence of major depressive episodes were lower in the intervention arm vs the care as usual group, indicating the DIL intervention administered by lay counselors is effective in preventing major depressive episodes in older adults with subsyndromal symptoms. The utility and scalability of the intervention should be further studied in low- and middle-income countries.
Dias A, Azariah F, Anderson SJ, et al. Effect of a lay counselor intervention on prevention of major depression in older adults living in low- and middle-income countries: a randomized clinical trial [published online November 7, 2018]. JAMA Psychiat. doi:10.1001/jamapsychiatry.2018.3048