A systematic review of community-based health interventions on depression for older adults with heart disease.
OBJECTIVE
This systematic review examined the effectiveness of community-based heart-health interventions on depression outcomes among homebound elderly (64 years and older) with heart disease.


METHODS
A comprehensive literature search and meta analysis was performed to evaluate randomized controlled trials examining outpatient or home-based interventions. Methodological quality was assessed by standard criteria developed by the Cochrane Collaborative Initiative.


RESULTS
Fifteen studies met our inclusion criteria and all measured depression outcomes. 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 effect sizes (ESs) ranged from -0.39 (in favor of control group) to 0.65 (in favor of treatment group). The mean weighted ES was 0.11 and six studies showed positive ESs.


CONCLUSIONS
Mixed evidence for community-based heart disease interventions on depression outcomes was found. Future research should include sub-analysis of ESs of interventions on depression outcomes by different demographic characteristics of the study sample, common depression outcome measures, and different follow-up periods.
Kang-Yi
Christina D
CD
Department of Psychiatry, Center for Mental Health Policy and Services Research, University of Pennsylvania School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA. dooyeon@mail.med.upenn.edu
Gellis
Zvi D
ZD
D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services; D003863:Depression / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006331:Heart Diseases / Q000523:psychology*; D018577:Homebound Persons; D006801:Humans; D008297:Male; D008875:Middle Aged