Effectiveness of late-life depression interventions on functional limitations: A systematic review.

Most included trials had unclear or high risk of bias; only two were judged low risk. The randomization process was poorly reported in many studies, and missing outcome data and selective reporting were common concerns. The studies used different depression definitions and different functional outcome measures, so results could not be pooled. Only the SF-36 among the included functional measures was validated in late-life depression, so some tests may have missed small changes. Most participants came from community or primary care settings, so findings may not apply to specialized mental health care. Many studies did not use a formal diagnostic procedure, which may have excluded the most depressed and frail older adults. Long-term follow-up was limited, and most studies did not show persistent functional benefit. Blinding of participants and staff was not possible in most trials because the interventions were psychological. The search was limited to English or Dutch articles and to two databases, so relevant studies may have been missed.

The review reports no external funding. No author conflict-of-interest declaration is stated.

Do not conclude that a case manager alone improves functioning. The positive collaborative-care studies were multicomponent team programs, and most trials had unclear or high risk of bias.