Psychological outreach programmes for the depressed elderly: a meta-analysis of effects and dropout.

Utilization of psychiatric services by depressed elderly is low compared to younger adults. Outreach programmes in which treatment is actively offered to depressed elderly in the community can be used to improve access of these elderly to mental health care. In this study a meta-analysis is carried out to study the effectiveness of these outreach programmes. Fourteen studies were found in which psychological treatment is offered to depressed elderly in the community. The effect size is large (0.77), comparable to the effect sizes found in younger adults. In a regression analysis it was found that the effect sizes of cognitive behavioural therapies are larger than those of other therapies. The mean dropout rate is 23%. It was also found that dropout was larger in group interventions, in cognitive behavioural therapies, in interventions with more female participants and in interventions offering more sessions. Analyses of the dropout rate should be part of every meta-analysis of intervention studies. Future research is needed to examine the differences between depressed persons who volunteer for a research programme and persons participating in an outreach programme. It is also necessary to examine if outreach programmes reach depressed persons who otherwise would not have sought help.