Depression Interventions for Latino Adults 50 Years and Older: A Systematic Review from 2012-2017

Background & Purpose: In the United States, depression disproportionately affects Latino adults.   Depression is the leading cause of disability worldwide, often chronic, and significantly impairs quality of life, especially when comorbid with other psychiatric or medical disorders. Currently, there are multiple Evidence Based Interventions for depression. However, few are developed and tested with Latinos adults and older adults. The objectives of this systematic review are to: 1) Identify and describe studies that investigate psychosocial interventions and their effects on depression among Latinos 50 years and older living in the US; and 2) Appraise their methodological quality and depression outcomes; and 3) Identify important gaps and limitations.

Methods: We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to conduct our review. We conducted a systematic search in three databases (Pubmed, Psycinfo, Google Scholar) and manual searches to identify articles written in English and published in peer-reviewed journals from 2012-2017. Search terms included terms for depression interventions and Latino groups. Articles were included if: 1) Article reported findings of a psychosocial intervention on depression; and 2) Study was conducted with a predominant (50% or more) sample of US based Latino adults 50 years or over (i.e., the mean must be 50 years or more) or explicitly report separately on a subsample of US Latino adults 50 years or over; and 3) Researchers used standardized tools to assess depression. All authors used the Methodological Quality Rating Scale (MQRS) to independently rate the methodological quality and abstracted key study information.

Results: Seven articles were included. Studies were conducted in California (3), Connecticut, Florida, Texas and Massachusetts. Study designs included four randomized controlled trials (RCT) and three pre-test, post-test single group reports. Sample sizes ranged from one to 400 participants. Only two studies reported a mean participant age of 60 years or older.  Multiple types of interventions were tested including collaborative care, diabetes management, occupational therapy and a fotonovela. Most interventions were delivered in hospital settings using individual or group modalities. Only two interventions explicitly addressed co-morbid depression (with diabetes).  Interventionists included Depression Care Specialists, Community Health Workers, lay workers and Master Level Social Workers. Based on MQRS score, study quality was strongest among RCT studies. Although favorable depression treatment effects were observed across all seven studies, collaborative care interventions showed the most promise. Multiple generalizability concerns were identified including: limited number of subgroups of Latinos, few interventions including older adults over the age of 60, and no reports regarding sexual and gender minorities.

 

Implications: Psychosocial Interventions to address depression among Latino adults 50 years and over are limited.  Given the large number of Latino adults in the United States, diversity across Latin American cultures, invisibility of sexual and gender minorities in this literature and increasing numbers of older adults in the US, researchers must make the development of acceptable, feasible and effective depression treatments for diverse Latino adults a research priority.