Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jul;63(7):439-446.
doi: 10.1177/0706743718760292. Epub 2018 Mar 1.

Integrated Care for Depression in Older Primary Care Patients

Martha L Bruce  1 , Jo Anne Sirey  2
Affiliations
Review

Integrated Care for Depression in Older Primary Care Patients

Martha L Bruce et al. Can J Psychiatry. 2018 Jul.

Abstract
in English, French

For decades, depression in older adults was overlooked and not treated. Most treatment was by primary care providers and typically poorly managed. Recent interventions that integrate mental health services into primary care have increased the number of patients who are treated for depression and the quality of that treatment. The most effective models involve systematic depression screening and monitoring, multidisciplinary teams that include primary care providers and mental health specialists, a depression care manager to work directly with patients over time and the use of guideline-based depression treatment. The article reviews the challenges and opportunities for providing high-quality depression treatment in primary care; describes the 3 major integrated care interventions, PRISM-E, IMPACT, and PROSPECT; reviews the evidence of their effectiveness, and adaptations of the model for other conditions and settings; and explores strategies to increase their scalability into real world practice.

Pendant des décennies, la dépression chez les adultes âgés a été ignorée et non traitée. Le traitement était majoritairement prodigué par des prestataires de soins de première ligne et habituellement mal pris en charge. Les interventions récentes qui intègrent les services de santé mentale aux soins de première ligne ont augmenté le nombre de patients qui sont traités pour la dépression ainsi que la qualité de ce traitement. Les modèles les plus efficaces emploient le dépistage et la surveillance systématiques de la dépression, des équipes multidisciplinaires qui comprennent des prestataires de soins de première ligne et des spécialistes de la santé mentale, un gestionnaire des soins de la dépression qui travaille directement avec les patients avec le temps et utilise le traitement de la dépression basé sur les lignes directrices. L’article examine les difficultés et les possibilités d’offrir un traitement de la dépression de grande qualité dans les soins de première ligne, puis décrit les trois principales interventions de soins intégrés, qui sont PRISM-E, IMPACT, et PROSPECT, présente les données probantes de leur efficacité, les adaptations du modèle à d’autres conditions et contextes, et les stratégies pour accroître leur flexibilité dans la pratique réelle.

Keywords: Care Management; Collaborative Care; Depression; Integrated Care; Older adults.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–1586. - PubMed
    1. Alexopoulos GS. Depression in the elderly. Lancet. 2005;365(9475):1961–1970. - PubMed
    1. Moussavi S, Chatterji S, Verdes E, et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370(9590):851–858. - PubMed
    1. Cooper-Patrick L, Crum RM, Ford DE. Characteristics of patients with major depression who received care in general medical and specialty mental health settings. Med Care. 1994;32(1):15–24. - PubMed
    1. Byers AL, Yaffe K, Covinsky KE, et al. High occurrence of mood and anxiety disorders among older adults: the national comorbidity survey replication. Arch Gen Psychiatry. 2010;67(5):489–496. - PMC - PubMed

MeSH terms

LinkOut - more resources