Public health efforts toward reducing depression in older people.
Public health efforts toward reducing depression in older people.
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旨在减少老年人抑郁症的公共卫生努力。
DOI：
10.1017/s1041610220003865
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发表时间：
2021
影响因子：
7
通讯作者：
Weisenbach,SaraL
中科院分区：
文献类型：
--
作者：
Khan,Nida;Weisenbach,SaraL
Xie等（2020）对中国5791名60岁以上社区居民进行了一项研究，调查了生物心理社会因素与抑郁症状的关系。结果表明，抑郁症状与社会人口学特征、不良健康状况、不健康习惯（饮酒和吸烟）和睡眠时间直接相关，而抑郁症状的主要预测因素是不良健康状况。这项研究强调了老年人抑郁症治疗中的一个重要概念：生活方式干预在老年人群中减少抑郁症症状的潜力。目前，在老年人群中研究最多的治疗方法是药物治疗和心理治疗。抗抑郁药是研究最多的，也是治疗抑郁症的主要药物。Xie et al.（2020）对4756名年龄在55岁及以上（平均年龄70岁）的重度抑郁症患者进行了荟萃分析，比较了抗抑郁药和安慰剂。结果表明抗抑郁药在治疗老年人群抑郁症状方面是有效的（Tedeschini et al., 2011）。然而，对于一个亚组患者（年龄0 ~ 65岁），抗抑郁药和安慰剂之间没有显著差异。这些分析受到异质性、80岁以上受试者试验数量有限以及排除重度抑郁症患者的限制。这些研究表明，抗抑郁药作为老年人抑郁症的治疗可能是有限的，应该考虑其他干预措施。心理治疗被认为是一种有用的，但在老年人群中未充分利用的治疗方式。一项包含27项试验的荟萃分析（共2000名患者）将心理治疗与对照组（等候组、常规治疗组、关注组、支持性治疗组、安慰剂组）进行了比较，发现心理治疗在减轻抑郁症状方面具有小到中等的临床效果。由于缺乏保险覆盖和治疗师的可用性，心理治疗目前在老年人群中的治疗受到限制（Huang et al., 2014）。然而，已经有许多临床试验将抑郁症的治疗纳入初级保健和家庭护理环境，并利用非博士水平的提供者，如护士和非专业健康咨询师作为精神卫生保健管理人员，证明了可行性和有效性（Bruce和Sirey， 2018）。体育锻炼也被研究为治疗抑郁症的一种潜在方式。对7项随机试验（n= 519例患者）进行了荟萃分析，其中运动定义为3至5次（30至45分钟/周），持续10周至6个月，与非运动对照组相比。分析发现，锻炼对减轻老年人抑郁症状有一个小的、临床意义重大的影响
Xie and colleagues (2020) conducted a study that investigated the relationship between biopsychosocial factors and symptoms of depression among 5791 primarily community-dwelling people older than 60 years in China. The results demonstrated a direct association of depressive symptoms with sociodemographic characteristics, poor health status, unhealthy habits (alcohol use and smoking), and sleep duration with the dominant predictor of depressive symptoms being poor health status. This study highlights an important concept in the treatment of depression in the elderly: the potential of lifestyle interventions to reduce symptoms of depression in the geriatric population. Currently, the treatments that have been most investigated in the geriatric population for depression are medications and psychotherapy. Antidepressants are the most studied and mainstay of treatment for depression. A meta-analysis of 15 randomized trials compared antidepressants with placebo in 4756 participants with Major Depressive Disorder, aged 55 years and older (mean age 70years old) Xie et al.(2020). Results demonstrated antidepressants to be effective in treating depressive symptoms in the geriatric population (Tedeschini et al., 2011). However, for a subgroup of patients (age> 65 years), there was no significant difference between antidepressants and placebo. These analyses were limited by the heterogeneity, the limited number of trials with participants older than age 80, and exclusion of individuals with severe depression. These studies suggest that antidepressants may be limited as a treatment of depression among older adults, and that other interventions should be considered. Psychotherapy is cited as a useful, but underutilized treatment modality in the geriatric population. A meta-analysis of 27 trials (n> 2000 patients) compared psychotherapy with control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo) and found a small-to-moderate clinical effect of therapy for reducing depressive symptoms. Due to lack of insurance coverage and availability of therapists, psychotherapy is currently limited as a treatment in the geriatric population (Huang et al., 2014). However, there have been a number of clinical trials integrating treatments of depression into primary care and home-based care settings, and utilizing non-doctoral level providers, such as nurses and lay health counselors as mental health care managers that demonstrate feasibility and effectiveness (Bruce and Sirey, 2018). Physical exercise has also been studied as a potential treatment modality for depression. A meta-analysis was performed of seven randomized trials (n= 519 patients) where exercise was defined as three to five sessions (30 to 45min/week) for 10weeks to 6 months, compared to non-exercise controls. Analysis found a small, clinically significant impact of exercise for reducing depressive symptoms among older people