title: Early intervention to preempt major depression among older black and white adults.
abstract: OBJECTIVE
  The study objective was to assess the efficacy of problem-solving therapy for primary care (PST-PC) for preventing episodes of major depression and mitigating depressive symptoms of older black and white adults. The comparison group received dietary coaching.
  
  
  METHODS
  A total of 247 participants (90 blacks, 154 whites, and three Asians) with subsyndromal depressive symptoms were recruited into a randomized depression prevention trial that compared effects of individually delivered PST-PC and dietary coaching on time to major depressive episode and level of depressive symptoms (Beck Depression Inventory) over two years. Cumulative intervention time averaged 5.5-6.0 hours in each study arm.
  
  
  RESULTS
  The two groups did not differ significantly in time to major depressive episodes, and incidence of such episodes was low (blacks, N=8, 9%; whites, N=13, 8%), compared with published rates of 20%-25% over one year among persons with subsyndromal symptoms and receiving care as usual. Participants also showed a mean decrease of 4 points in depressive symptoms, sustained over two years. Despite greater burden of depression risk factors among blacks, no significant differences from whites were found in the primary outcome.
  
  
  CONCLUSIONS
  Both PST-PC and dietary coaching are potentially effective in protecting older black and white adults with subsyndromal depressive symptoms from developing episodes of major depression over two years. Absent a control for concurrent usual care, this conclusion is preliminary. If confirmed, both interventions hold promise as scalable, safe, nonstigmatizing interventions for delaying or preventing episodes of major depression in the nation's increasingly diverse older population.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Thomas
authors.forename: Jennifer Q
authors.initials: JQ
authors.lastname: Morse
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Anderson
authors.forename: Steven
authors.initials: S
authors.lastname: Albert
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Amy
authors.initials: A
authors.lastname: Begley
authors.forename: Jordan F
authors.initials: JF
authors.lastname: Karp
authors.forename: Ariel
authors.initials: A
authors.lastname: Gildengers
authors.forename: Meryl A
authors.initials: MA
authors.lastname: Butters
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Stack
authors.forename: John
authors.initials: J
authors.lastname: Kasckow
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Quinn
mesh_terms: D001741:Black or African American; D000368:Aged; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000517:prevention & control*; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011340:Problem Solving; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome; D044465:White People