Résumés
Résumé
La dépression est un problème répandu, sérieux, et souvent chronique chez les aînés, qui sont souvent atteints de maladies physiques chroniques, et affecte de façon négative leurs traitements et leurs soins. Malheureusement, le taux de détection et de suivi adéquat de la dépression est faible dans cette population. Au cours des deux dernières décennies, notre équipe a mené une série d’études pour mieux comprendre et améliorer la gestion de la dépression chez les aînés. Nous présentons une revue narrative et synthèse de 25 articles qui incluent : 4 revues systématiques, 10 études observationnelles, 9 essais d’interventions, et 2 conférences de consensus. Nous proposons en conclusion nos recommandations pour 1) la détection de la dépression dans les soins de santé primaires ; 2) les soins collaboratifs de la dépression ; 3) des interventions d’autogestion de la dépression ; 4) le rôle des aidants naturels dans les interventions d’autogestion de la dépression.
Mots-clés :
- dépression,
- soins primaires,
- soins collaboratifs,
- interventions d’autogestion de soins,
- rôle aidants naturels
Abstract
Objectives A research group based at St. Mary’s Research Centre, St. Mary’s Hospital, Montreal, has conducted a research program over the past two decades that aims to inform improvements in the management of depression in primary care and general medical settings, among older adults. This paper reviews the findings from this research program, discusses the findings in the context of other research, and highlights the implications for practice and health policy.
Methods Narrative review and synthesis of 25 published articles, that included: 4 systematic reviews, 10 observational studies, 9 intervention trials, and 2 consensus conference reports.
Results The results pertain to 4 research areas: detection of depression in primary care and general medical settings; collaborative care of depression; depression self-care interventions; and the role of family and friends in supporting depression self-care interventions.
Conclusions We propose six recommendations for improving the management of depression in the target population. 1) Depression detection and treatment can be improved through collaborative care models that involve primary care physicians, mental health specialists and non-physician mental health workers who are trained to assist with the detection of depression, with the delivery of brief, low-intensity psychological interventions and with self-care support. More research and evaluation are necessary to determine the factors that enhance the effectiveness, cost-efficiency, and consumer-centeredness of these interventions. 2) Supported depression self-care (and other low-intensity interventions such as short problem-solving therapy) offered by telephone or via internet, either as part of collaborative or usual care are feasible treatment options but more research is necessary to determine their effectiveness in different clinical populations. Some populations (e.g., those aged 75 and over, with visual and/or mild cognitive impairment) are likely to need greater or face-to-face support. 3) As most family physicians are unlikely to have the necessary time or interest to support depression self-care interventions, other sustainable programmatic contexts are needed for delivery of these interventions. Options include: nurses or other mental health workers in multidisciplinary family medicine groups; regional mental health programs; and voluntary organizations dedicated to assisting in the management of chronic illnesses. Research is needed on the feasibility and effectiveness of using peer support workers or volunteers to provide coaching of depression self-care interventions. 4) Involvement of family or friends in depression self-care may improve outcomes (e.g., dyadic interventions) but further research is necessary. 5) Further research should explore the potential of depression self-care interventions to prevent major depression and in depression relapse prevention in this population.
Keywords:
- depression,
- primary care,
- collaborative care,
- self-care interventions,
- role of caregivers
Parties annexes
Bibliographie
- 1. Cole, M. G., Bellavance, F. et Mansour, A. (1999). Prognosis of depression in elderly community and primary care populations : A systematic review and meta-analysis. The American Journal of Psychiatry, 156(8), 1182-1189.
- 2. Cole, M. G., McCusker, J., Elie, M., Dendukuri, N., Latimer, E. et Belzile, E. (2006). Systematic detection and multidisciplinary care of depression in older medical inpatients : A randomized trial. Canadian Medical Association Journal, 174(1), 38-44.
- 3. Cole, M. G. et Yaffe, M. J. (1996). Pathway to psychiatric care of the elderly with depression. International Journal of Geriatric Psychiatry, 11(2), 157-161.
- 4. Cole, M. G., McCusker, J., Sewitch, M., Ciampi, A. et Dyachenko, A. (2008). Health services use for mental health problems by community-living seniors with depression. International Psychogeriatrics, 20(3), 554-570.
- 5. Cepoiu, M., McCusker, J., Cole, M. G., Sewitch, M., Belzile, E. et Ciampi, A. (2008). Recognition of depression by non-psychiatric physicians : A systematic literature review and meta-analysis. Journal of General Internal Medicine, 23(1), 25-36.
- 6. Cepoiu, M., McCusker, J., Cole, M. G., Sewitch, M. et Ciampi, A. (2007). Recognition of depression in older medical inpatients. Journal of General Internal Medicine, 22(5), 559-564.
- 7. McCusker, J., Cole, M., Latimer, E., Sewitch, M., Ciampi, A., Cepoiu, M. et Belzile, E. (2008). Recognition of depression in older medical inpatients discharged to ambulatory care settings : A longitudinal study. General Hospital Psychiatry, 30(3), 245-251.
- 8. Ouadahi, Y., Lesage, A., Rodrigue, J. et Fleury, M. J. (2009). Les problèmes de santé mentale sont-ils détectés par les omnipraticiens ? Regard sur la perspective des omnipraticiens selon les banques de données administratives. Santé mentale au Québec, 34(1), 161-172.
- 9. Kates, N., Mazowita, G., Lemire, F., Jayabarathan, A., Bland, R., Selby, P. . . . Audet, D. (2011). The evolution of collaborative mental health care in Canada : A shared vision for the future. Canadian Journal of Psychiatry, 56(5), 1-10.
- 10. Yaffe, M. J., Primeau, F., McCusker, J., Cole, M. G., Belzile, E., Dendukuri, N. . . . Laplante, J. (2005). Psychiatric outpatient consultation for seniors. Perpectives of family physicians, consultants, and patients/ family : A descriptive study. BMC Family Practice, 6(15), 1-8.
- 11. Lévesque, J., Feldman, D., Dufresne, C., Bergeron, P. et Pinard, B. (2007). L’implantation d’un modèle intégré de prévention et de gestion des maladies chroniques au Québec. Barrières et éléments facilitant. Québec : Agence de la santé et des services sociaux de Montréal/Direction de santé publique et Institut national de santé publique.
- 12. Unutzer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L. . . . Langston, C. (2002). Collaborative care management of late-life depression in the primary care setting. A randomized controlled trial. JAMA, 288(22), 2836-2845.
- 13. McCusker, J., Cole, M., Yaffe, M. J., Cappeliez, P., Dawes, P., Sewitch, M. . . . Latimer, E. (2008). Project direct : Pilot study of a collaborative intervention for depressed seniors. Canadian Journal of Community Mental Health, 27(2), 201-218.
- 14. Sussman, T., Yaffe, M., McCusker, J., Parry, D., Sewitch, M., Van Bussel, L. et Ferrer, I. (2011). Improving the management of late-life depression in primary care : Barriers and facilitators. Depression Research and Treatment, 2011, 1-7.
- 15. McCusker, J., Yaffe, M., Sussman, T., Kates, N., Mulvale, G., Jayabarathan, A. . . . Haggerty, J. (2013). Developing an evaluation framework for consumer-centred collaborative care of depression using input from stakeholders. The Canadian Journal of Psychiatry, 58(3), 160-168.
- 16. Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L. . . . Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews, 10, CD006525.
- 17. McCusker, J., Cole, M., Keller, E., Bellavance, F. et Berard, A. (1998). Effectiveness of treatments of depression in older ambulatory patients. Archives of Internal Medicine, 158, 705-712.
- 18. Fansi, A. (2015). Avis sur l’accès équitable aux services de psychothérapie. [Québec] : INESSS, Institut national d’excellence en santé et en services sociaux.
- 19. Cuijpers, P., Donker, T., Van Straten, A., Li, J., et Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders ? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40(12), 1943-1957.
- 20. Tsai, A. C., Morton, S. C., Mangione, C. M. et Keeler, E. B. (2005). A meta-analysis of interventions to improve care for chronic illnesses. The American Journal of Managed Care, 11(8), 478-488.
- 21. Wagner, E. H. (1998). Chronic disease management : What will it take to improve care for chronic illness ? Effective Clinical Practice, 1, 2-4.
- 22. Liddy, C. et Mill, K. (2014). An environmental scan of policies in support of chronic disease self-management in canada. Chronic Diseases and Injuries in Canada, 34(1), 55-63.
- 23. Bilsker, D., Goldner, E. M. et Anderson, E. (2012). Supported self-management : A simple, effective way to improve depression care. Canadian Journal of Psychiatry, 57(4), 203-209.
- 24. Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S. et Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms ? Meta-analysis and meta-regression. Psychological Medicine, 37(9), 1217-1228.
- 25. Houle, J., Gascon-Depatie, M., Belanger-Dumontier, G. et Cardinal, C. (2013). Depression self-management support : A systematic review. Patient Education and Counseling, 91(3), 271-279.
- 26. McCusker, J., Cole, M., Yaffe, M., Strumpf, E., Sewitch, M. et Sussman, T. (2015a). The DIRECT-sc depression self-care research program. Récupéré de http://www.stmarysresearch.ca/en/publications_and_tools/scientific-publications/the-directsc-depression-selfcare-research-program
- 27. McCusker, J., Cole, M., Yaffe, M., Sussman, T., Lavoie, K. L., Strumpf, E. . . . de Raad, M. (2012). A feasibility study of a telephone-supported self-care intervention for depression among adults with a comorbid chronic physical illness in primary care. Mental Health Family Medicine, 9(4), 257-273.
- 28. McCusker, J., Cole, M., Lambert, S., Yaffe, M., Ciampi, A. et Belzile, E. (2016a). Baseline psychological treatment reduces the effect of coaching in a randomized trial of a depression self-care intervention Canadian Journal of Psychiatry. doi :10.1177/0706743716648299
- 29. McCusker, J., Cole, M. G., Yaffe, M., Strumpf, E., Sewitch, M., Sussman, T. . . . Belzile, E. (2015b). A randomized trial of a depression self-care toolkit with or without lay telephone coaching for primary care patients with chronic physical conditions. General Hospital Psychiatry, 37 (3), 257-265. [Corrigendum : General Hospital Psychiatry, 240 : 275-283, 2016].
- 30. Cole, M. G., McCusker, J., Yaffe, M., Strumpf, E., Sewitch, M., Sussman, T. . . . Belzile, E. (2015). Supported depression self-care may prevent major depression in community-dwelling older adults with chronic physical conditions and co-morbid depressive symptoms. [Letter to the Editor]. International Psychogeriatrics, 27(6), 1049-1050.
- 31. McCusker, J., Cole, M., Yaffe, M., Strumpf, E., Sewitch, M., Sussman, T. . . . Belzile, E. (2016b). Adherence to a depression self-care intervention among primary care patients with chronic physical conditions : A randomized controlled trial. Health Education Journal.
- 32. Johnston, S. E., Liddy, C. E. et Ives, S. M. (2011). Self-management support : A new approach still anchored in an old model of health care. Canadian Journal of Public Health, 102(1), 68-72.
- 33. Ostbye, T., Kristjansson, B., Hill, G., Newman, S. C., Brouwer, R. N. et McDowell, I. (2005). Prevalence and predictors of depression in elderly Canadians : The Canadian Study of Health and Aging. Chronic Diseases in Canada, 26(4), 93-99.
- 34. Yaffe, M. J., Cole, M., McCusker, J., Sussman, T., Sewitch, M., Sahin, D. . . . Belzile, E. (2015). What is the potential for family physicians to coach patients’ self-care of depression : An exploratory study. Mental Health in Family Medicine, 11, 53-58.
- 35. McCusker, J., Lambert, S., Cole, M., Ciampi, A., Freeman, E. et Belzile, E. (2016). Activation and self-efficacy in a randomized trial of a depression self-care intervention among primary care patients with chronic physical conditions. Health education and behavior, 43(6), 716-725.
- 36. Kamga, H., McCusker , J., Yaffe, M., Sewitch, M., Sussman, T., Strumpf, E. . . . Freeman, E. (2016). Self-care tools to treat depressive symptoms in patients with age-related eye disease : A randomized controlled clinical trial. Clinical and Experimental Ophthalmology, 1-8.
- 37. Rosland, A.-M. et Piette, J. D. (2010). Emerging models for mobilizing family support for chronic disease management : A structured review. Chronic Illness, 6(1), 7-21.
- 38. McCusker, J., Latimer, E., Cole, M., Ciampi, A. et Sewitch, M. (2007). Major depression among medically ill elders contributes to sustained poor mental health in their informal caregivers. Age and Ageing, 36(4), 400-406.
- 39. Sewitch, M. J., McCusker, J., Dendukuri, N., et Yaffe, M. J. (2004). Depression in frail elders : Impact on family caregivers. International Journal of Geriatric Psychiatry, 19(7), 655-665.
- 40. McCusker, J., Latimer, E., Cole, M., Ciampi, A. et Sewitch, M. (2009). The nature of informal caregiving for medically ill older people with and without depression. International Journal of Geriatric Psychiatry, 24(3), 239-246.
- 41. Sussman, T., McCusker, J., Yaffe, M., Belzile, E., Sewitch M, Cole, M. et Strumpf, E. (2016). Family members’s/friends involvement in self-care for patients with depressive symptoms and co-morbid chronic conditions. Chronic Illness.
- 42. Sussman, T., Yaffe, M., McCusker, J., Burns, V., Strumpf, E., Sewitch, M. et Belzile, E. (2014). A mixed methods exploration of family members’/friends’ roles in a self-care intervention for depression. Chronic Illness, 10(2), 93-106.
- 43. Weinerman, R., Campbell, H., Miller, M., Stretch, J., Kallstrom, L., Kadlec, H. et Hollander, M. (2011). Improving mental healthcare by primary care physicians in British Columbia. Healthcare Quarterly, 14(1), 36-38.
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