Effects of a Depression Care Program Including a Pleasant Activities Plan and a Life Review Therapy on Depressive Symptoms and Apathy in Nursing Home Residents

Background: Depression is common in nursing home (NH) residents. Pharmacological depression treatment is mostly used but may induce apathy, which overlaps with depression in motivational symptoms. Objective: To determine effectiveness of a NH depression program including stepped-care treatment with positive psychosocial interventions (pleasant-activities plan and life review therapy) and a pharmacological protocol. Design: Stepped-wedge cluster-randomized trial, 5 intervention groups, 6 measurements; 16 dementia special care (DSC) and 17 somatic NH units; 403 DSC, 390 somatic residents. Measurements: Apathy: 10-item Apathy Evaluation Scale; motivational depressive symptoms: the items retardation, loss of interest, appetite loss, weight loss, and lack of energy of Cornell Scale for Depression in Dementia. Results: The program reduced apathy in DSC units (-2.3 [95% CI, -3.3 to -1.3]; p< 0.001), and motivational symptoms in somatic units (-0.4 [95% CI, -0.7 to -0.1]; p=0.008). The effect in DSC residents was mainly attributable to activating strategies, the effect in somatic residents to psychotherapy including life review therapy. Pharmacological depression treatment was associated with apathy worsening. Conclusions: Activating depression treatment strategies can be used effectively in DSC residents, and psychotherapy based on life review therapy in somatic residents. More research is needed on implementing positive psychosocial interventions in NHs.