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Review
. 2017 Sep 22;12(9):e0184666.
doi: 10.1371/journal.pone.0184666. eCollection 2017.

Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis

Floor Holvast  1 , Btissame Massoudi  1 , Richard C Oude Voshaar  2 , Peter F M Verhaak  1   3
Affiliations
Review

Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis

Floor Holvast et al. PLoS One. .

Abstract

Background: Late-life depression is most often treated in primary care, and it usually coincides with chronic somatic diseases. Given that antidepressants contribute to polypharmacy in these patients, and potentially to interactions with other drugs, non-pharmacological treatments are essential. In this systematic review and meta-analysis, we aimed to present an overview of the non-pharmacological treatments available in primary care for late-life depression.

Method: The databases of PubMed, PsychINFO, and the Cochrane Central Register of Controlled Trials were systematically searched in January 2017 with combinations of MeSH-terms and free text words for "general practice," "older adults," "depression," and "non-pharmacological treatment". All studies with empirical data concerning adults aged 60 years or older were included, and the results were stratified by primary care, and community setting. We narratively reviewed the results and performed a meta-analysis on cognitive behavioral therapy in the primary care setting.

Results: We included 11 studies conducted in primary care, which covered the following five treatment modalities: cognitive behavioral therapy, exercise, problem-solving therapy, behavioral activation, and bright-light therapy. Overall, the meta-analysis showed a small effect for cognitive behavioral therapy, with one study also showing that bright-light therapy was effective. Another 18 studies, which evaluated potential non-pharmacological interventions in the community suitable for implementation, indicated that bibliotherapy, life-review, problem-solving therapy, and cognitive behavioral therapy were effective at short-term follow-up.

Discussion: We conclude that the effects of several treatments are promising, but need to be replicated before they can be implemented more widely in primary care. Although more treatment modalities were effective in a community setting, more research is needed to investigate whether these treatments are also applicable in primary care.

Trial registration: PROSPERO CRD42016038442.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram of study selection.
Fig 2
Fig 2. Risk of bias assessment for the included randomized controlled trials.
Based on the Cochrane Collaboration’s tool for assessing risk of bias, + indicates low risk of bias,—indicates high risk of bias, and? indicates unclear risk of bias.
Fig 3
Fig 3. Forrest plot of the meta-analysis for studies of cognitive behavioral therapy in primary care.
Control condition entered in meta-analyses specified by study: Arean (2005) [24] used clinical case-management; but, Laidlaw (2008) [28], Lamers (2010) [29], Serfaty (2009) [31] used care as usual. One of the two reported outcome measurements by Laidlaw was used in the meta-analyses, namely HRSD.
See this image and copyright information in PMC

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Grants and funding

This work was supported by the Netherlands Organization for Health Research and Development (https://www.zonmw.nl/en/, grant number 839110009), and the funding applicant was PV. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.