title: Early intervention to reduce the global health and economic burden of major depression in older adults.
abstract: Randomized trials for selective and indicated prevention of depression in both mixed-aged and older adult samples, conducted in high-income countries (HICs), show that rates of incident depression can be reduced by 20-25% over 1-2 years through the use of psychoeducational and psychological interventions designed to increase protective factors. Recurrence of major depression can also be substantially reduced through both psychological and psychopharmacological strategies. Additional research is needed, however, to address the specific issues of depression prevention in older adults in low- and middle-income countries (LMICs). The growing number of older adults globally, as well as workforce issues and the expense of interventions, makes it important to develop rational, targeted, and cost-effective risk-reduction strategies. In our opinion, one strategy to address these issues entails the use of lay health counselors (LHCs), a form of task shifting already shown to be effective in the treatment of common mental disorders in LMICs. We suggest in this review that the time is right for research into the translation of depression-prevention strategies for use in LMICs.
authors.affiliation: School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. Reynoldscf@upmc.edu
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.forename: Alex
authors.initials: A
authors.lastname: Cohen
authors.forename: Amit
authors.initials: A
authors.lastname: Dias
authors.forename: Neerja
authors.initials: N
authors.lastname: Chowdhary
authors.forename: Olivia I
authors.initials: OI
authors.lastname: Okereke
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Anderson
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.forename: Frank
authors.initials: F
authors.lastname: Lotrich
authors.forename: Steven M
authors.initials: SM
authors.lastname: Albert
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D003150:Community Health Workers / Q000458:organization & administration; D017281:Cost of Illness; D003865:Major Depressive Disorder / Q000191:economics / Q000517:prevention & control*; D019049:Developed Countries; D003906:Developing Countries; D061345:Early Medical Intervention / Q000191:economics / Q000706:statistics & numerical data; D014943:Global Health; D006801:Humans; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data; D011322:Primary Prevention; D011634:Public Health; D018570:Risk Assessment
chemical_list: D000928:Antidepressive Agents