The prevention of depression in individuals who are at risk is important for affected individuals, their family members, and for society at large. This study presents the results of a randomized clinical trial aimed at the prevention of depression in nursing home residents. Residents were screened with the Geriatric Depression Scale (GDS) and a diagnostic interview. Those with elevated GDS scores who did not meet diagnostic criteria for depression were randomly assigned to a treatment or control (treatment as usual, TAU) condition. The treatment was an adaptation of the Coping with Stress program developed by Clarke et al. (1995; Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312-321), and focused on various components typical of cognitive-behavioral treatment (CBT) programs (e.g. increasing pleasant events, reducing negative cognitions). Both groups were assessed on measures of depression before treatment, after treatment, and at 3- and 6-month follow-up points. Compared with the TAU group, residents receiving the intervention showed considerable improvement over the 6-month follow-up on the GDS. Average scores on the GDS, for example, went from 14.0 to 9.4 in the CBT group over the course of treatment and follow-up, vs. scores from 13.4 to 12.3 for the TAU group over the same time. However, results on the Center for Epidemiological Studies Depression Scale at 3 months were nonsignificant. Overall, the results of this study suggest that a brief, group-based CBT program can have significant benefit in nursing home residents at risk for depression.

RÉSUMÉAu fur et à mesure de l'augmentation du nombre d'ainé(e)s dans les établissements de soins de longue durée, les professionnel(le)s de la santé mentale fourniront plus de services et mèneront plus d'enquêtes dans ce milieu. Les professionnel(le)s de la santé mentale s'occupant de patients nécessitant des soins de longue durée se retrouveront régubèrement aux prises avec des questions de morale, surtout en matière de consentement éclairé. Les caractéristiques du milieu des soins de longue durée et de ses résidents rendent le consentement éclairé particulièrement délicat. Les professionnels de la santé mentale doivent relever les défis qui s'y relient pour respecter les critères suivants du consentement éclairé: (1) le client est compétent, (2) le client dispose de toute l'information nécessaire, et (3) le client n'a pas été contraint et/ou le consentement est volontaire. L'article examine la question de ces critères dans un milieu de soins de longue durée et propose des suggestions et des directives à utiliser par les professionnels de la santé mentale qui ont à obtenir un consentement éclairé.