Clinical Review Article
Depression Interventions Among Racial and Ethnic Minority Older Adults: A Systematic Review Across 20 Years

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While there is strong evidence in support of geriatric depression treatments, much less is available with regard to older U.S. racial and ethnic minorities. The objectives of this review are to identify and appraise depression treatment studies tested with samples of U.S. racial and ethnic minority older adults. We include an appraisal of sociocultural adaptations made to the depression treatments in studies meeting our final criteria. Systematic search methods were utilized to identify research published between 1990 and 2010 that describe depression treatment outcomes for older adults by racial/ethnic group, or for samples of older adults who are primarily (i.e., >50%) racial/ethnic minorities. Twenty-three unduplicated articles included older adults and seven met all inclusion criteria. Favorable depression treatment effects were observed for older minorities across five studies that took place in different types of settings and with varying levels of sociocultural adaptations. The effectiveness of depression care remains mixed, although collaborative or integrated care shows promise for African Americans and Latinos. The degree to which the findings generalize to non–English-speaking, low acculturated, and low-income older persons, and to other older minority groups (i.e., Asian and Pacific Islanders, and American Indian and Alaska Natives), remains unclear. Given the high disease burden among older minorities with depression, it is imperative to provide timely, accessible, and effective depression treatments. Increasing their participation in behavioral health research should be a national priority.

Section snippets

Search Strategy

In early 2011, we searched five electronic databases for peer-reviewed articles published in the previous two decades that examined depression treatment outcomes among older minorities. In addition, we consulted with experts in the field, conducted electronic searches on the basis of the search engines of four mental health journals, using similar key words, and manually searched through the reference lists of 18 review articles focused on depression treatment in older adults (see Table 1).

The

RESULTS

The comprehensive search identified nearly 82,000 studies that focused on depression, more than 16,000 that addressed depression treatment, and 1,068 among broadly defined minority populations. Of the 1,068 unduplicated articles, 80 reported depression treatment outcomes by minority group or for a sample comprising greater than 50% racial or ethnic minorities, and 19 of these included older adults. Four additional articles were identified through expert consultation, key word searches in four

CONCLUSIONS

Through an exhaustive systematic review process spanning published literature over 20 years, we analyzed seven studies reporting depression treatment outcomes for older minorities in the United States. Several conclusions can be drawn albeit with caution, given the small number of studies that met our criteria. First, the amount of evidentiary support of depression treatment among older minorities has been slowly emerging since the seminal publication of the Surgeon General Report on Mental

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    Preparation of this manuscript was supported by a grant from the National Institute of Mental Health, grant R21MH080624 (Dr. Aranda, PI). This article is the result of the work supported with resources from the Edward R. Roybal Institute on Aging at the School of Social Work, University of Southern California (Ms. Fuentes). This work was presented at the 64th Annual Scientific Meeting of The Gerontological Society of America, Boston, MA, November 2011.

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