Systematic review of dyadic and family-oriented interventions for late-life depression.

OBJECTIVE: Supportive behaviors (both instrumental and emotional) from spouses and close family members can impact the trajectory of older adults' depressive symptoms. Interventions that target both the patient and support person may be more effective than interventions that target the patient only, in terms of alleviating mood symptoms in the identified patient. The purpose of this paper was to review the characteristics and findings of dyadic and family-oriented interventions for late-life mood disorders to determine if they are effective and beneficial. METHODS: Following PRISMA guidelines, we conducted a systematic review of reports in the literature on dyadic or family-oriented interventions for late-life mood disorders. We searched PubMed, OVID PsycINFO, and EMBASE for peer-reviewed journal articles in English through October 2014. RESULTS: We identified 13 articles, representing a total of 10 independent investigations. Identified studies focused on spouses and close family members as support persons. Effect sizes for dyadic interventions that treated major depressive disorder were, on average, moderately strong, while effect sizes for dyadic interventions that reduced depressive symptoms were generally small. We did not identify any dyadic studies that treated bipolar disorder. CONCLUSIONS: This review showed that dyadic interventions are feasible and that these interventions can decrease symptomatology in individuals who have major depressive disorder. Research is needed to understand the relative efficacy of a dyadic approach over a single-target approach in treating depression. Copyright © 2016 John Wiley & Sons, Ltd.

Inflammatory markers and the pathogenesis of pediatric depression and suicide: a systematic review of the literature.

OBJECTIVE: To evaluate the relationship and identify support for pathways linking inflammatory processes with depression and suicide in children and adolescents. DATA SOURCES: We designed and implemented comprehensive literature searches in MEDLINE, PsycINFO, and EMBASE. We searched the databases with database-specific controlled vocabulary in conjunction with keywords (eg, inflammation, interleukin, cytokine, C-reactive protein, depression, suicide) in various combinations for reports published in English through May 2013. STUDY SELECTION: The searches identified a total of 1,543 citations, of which 55 were selected for further review and ultimately 27 were identified for inclusion. Studies were selected using 2 criteria. The first criterion required that studies include a biological measure of inflammatory markers in childhood or adolescence. The second criterion required that the studies include a measure of depression or suicide in childhood or adolescence. Articles selected for the review were based on the use of standardized experimental procedures and validated assessment measures. DATA EXTRACTION: All articles were assessed by 2 authors, which ensured that the inclusion criteria were met. Studies were reviewed for association of inflammatory markers with depression and/or suicide. Extracted data included authors, year of publication, study design, population characteristics, inflammatory markers, and depression/suicide measures. Significant and nonsignificant findings were tabulated. RESULTS: The majority of studies were on depression; 2 studies were on suicide, and 7 studies were on inflammatory medical conditions. Most of the participants were adolescents. Interleukin (IL)-1α, IL-1ß, IL-1 receptor antagonist, IL-2, soluble IL-2 receptors, IL-4, IL-6, IL-10, interferon-γ, tumor necrosis factor-α, C-reactive protein, erythrocyte sedimentation rate, and inflammatory cells were assayed across the studies. There was extensive variation in depression measures. Five of the 9 cross-sectional and 3 of the 7 longitudinal studies on depression found a positive association between inflammation and depression. In 3 studies evaluating depression and early adversity, inflammation was more significantly related to adversity than depression was. Results from studies of medical conditions involving inflammation and depression were mixed. CONCLUSIONS: The extant literature provides sufficient data to support a link between inflammatory processes and pediatric depression. However, the directionality of the associations and pathways between the 2 conditions remains to be elucidated. At present, there is insufficient evidence to support the relationship between inflammation and suicidality in youth. Studies on inflammatory medical conditions are warranted in order to understand biological pathways linking inflammation and depression.

Review and meta-analysis of couple-oriented interventions for chronic illness.

BACKGROUND: Evidence continues to build for the impact of the marital relationship on health as well as the negative impact of illness on the partner. Targeting both patient and partner may enhance the efficacy of psychosocial or behavioral interventions for chronic illness. PURPOSE: The purpose of this report is to present a cross-disease review of the characteristics and findings of studies evaluating couple-oriented interventions for chronic physical illness. METHODS: We conducted a qualitative review of 33 studies and meta-analyses for a subset of 25 studies. RESULTS: Identified studies focused on cancer, arthritis, cardiovascular disease, chronic pain, HIV, and Type 2 diabetes. Couple interventions had significant effects on patient depressive symptoms (d = 0.18, p < 0.01, k = 20), marital functioning (d = 0.17, p < 0.01, k = 18), and pain (d = 0.19, p < 0.01, k = 14) and were more efficacious than either patient psychosocial intervention or usual care. CONCLUSIONS: Couple-oriented interventions have small effects that may be strengthened by targeting partners' influence on patient health behaviors and focusing on couples with high illness-related conflict, low partner support, or low overall marital quality. Directions for future research include assessment of outcomes for both patient and partner, comparison of couple interventions to evidence-based patient interventions, and evaluation of mechanisms of change.