Coping with health stresses and remission from late-life depression in primary care: a two-year prospective study

Objectives: Identifying the predictors of late-life depression that are amenable to change may lead to interventions that result in better and faster remission. Thus, the authors investigated the impact of two different strategies for coping with physical illness on depression in older, primary care patients. Health-oriented goal engagement strategies involve the investment of cognitive and behavioral resources to achieve health goals. Conversely, disengagement strategies involve the withdrawal of these resources from obsolete or unattainable health goals, combined with goal restructuring. Methods: The participants were 271 adults aged >59 years who took part in a two-year randomized clinical trial for treating depression in older adults (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). The use of engagement and disengagement strategies, along with other risk factors for depression, were included in a tree-structured survival analysis to identify subgroups of individuals at risk for not achieving depression remission. Results: The use of disengagement strategies predicted earlier remission of depression, particularly among more severely depressed older patients. The use of engagement strategies did not predict earlier remission. Conclusion: Interventions that encourage disengagement from unattainable health goals may promote remission from depression in older, primary care patients. Copyright (C) 2011 John Wiley & Sons, Ltd.