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Treatment in Psychiatry   |    
Coaching in Healthy Dietary Practices in At-Risk Older Adults: A Case of Indicated Depression Prevention
Sarah T. Stahl, Ph.D.; Steven M. Albert, Ph.D.; Mary Amanda Dew, Ph.D.; Michael H. Lockovich, L.C.S.W.; Charles F. Reynolds, III, M.D.
Am J Psychiatry 2014;171:499-505. doi:10.1176/appi.ajp.2013.13101373
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Dr. Reynolds has received pharmaceutical support for NIH-sponsored research studies from Bristol-Myers Squibb, Eli Lilly, Forest, and Pfizer; grants from NIMH, the National Institute on Aging, the National Center for Minority Health Disparities, the National Heart, Lung, and Blood Institute, the Centers for Medicare and Medicaid Services, the Patient-Centered Outcomes Research Institute, the Commonwealth of Pennsylvania, the John A. Hartford Foundation, the National Palliative Care Research Center, the Clinical and Translational Science Institute, and the American Foundation for Suicide Prevention; and a speaking honorarium from Medscape/WebMD; he has also received licensing fees for psychometric analysis of the Pittsburgh Sleep Quality Index (PRO10050447). The other authors report no financial relationships with commercial interests.

Supported in part by NIH grants P30 MH090333, P60 MD000207, MHO19986, NR009573, NR013450, R01 NR012459, CDC U48 DP001918, UL1RR024153, UL1TR00000, 5AG026010, and AG032370; by National Science Foundation grant 0540865; and by the University of Pittsburgh Medical Center Endowment in Geriatric Psychiatry.

Clinicaltrials.gov identifier: NCT00326677.

From the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh; and the University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh.

Address correspondence to Dr. Reynolds (reynoldscf@upmc.edu).

Copyright © 2014 by the American Psychiatric Association

Received October 07, 2013; Revised December 20, 2013; Accepted December 30, 2013.


Prevention of major depressive disorder is important because current treatments are only partially adequate in reducing symptom burden and promoting health-related quality of life. Lifestyle interventions may be a desirable prevention strategy for reasons of patient preference, particularly among older patients from minority groups. Using evidence from a randomized depression prevention trial for older adults, the authors found that coaching in healthy dietary practices was potentially effective in protecting at-risk older adults from developing incident episodes of major depression. The authors describe the dietary coaching program (highlighted in a case example) as well as the feasibility and potential efficacy of the program within the context of evidence-based interventions for preventing episodes of major depression and mitigating symptoms of depression. Older adults receiving dietary coaching experienced a low incidence of major depressive episodes and exhibited a 40%−50% decrease in depressive symptoms, as well as enhanced well-being, during the initial 6-week intervention; these gains were sustained over 2 years. The authors also describe why lifestyle interventions like coaching in healthy dietary practices may hold promise as effective, practical, nonstigmatizing interventions for preventing episodes of major depressive disorder in older adults with subsyndromal depressive symptoms.

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