Isabell Schierenbeck

Psychosocial interventions for the prevention of depression in older adults: systematic review and meta-analysis

Objectives: To assess the effectiveness of psychosocial interventions for the prevention of depression in older people. Method: Systematic review and meta-analysis of prospective controlled trials. Results: Thirty studies were included. Overall, psychosocial interventions had a small but statistically significant effect on depressive symptoms (17 trials, standardized mean difference = -0.17, 95% CI = -0.31 to -0.03). In comparison with no-intervention controls, social activities were effective in reducing depressive symptoms, but results should be interpreted with caution due to the small number of trials. No statistically significant effect on depressive symptoms was found for physical exercise, skill training, reminiscence, or for multicomponent interventions. Discussion: Psychosocial interventions have a small but statistically significant effect in reducing depressive symptoms among older adults. The current evidence base for psychosocial interventions for primary prevention of depression in older people is weak, and further trials warranted especially for the most promising type of interventions evaluated, that is, social activities.

Structural and cognitive social capital and depression among older adults in two Nordic regions

Objective: To study the association between structural and cognitive aspects of social capital and depression among older adults in two Nordic regions. Method: Data were retrieved from a postal survey targeting older adults aged 65, 70, 75 and 80 years (N = 6 838, response rate = 64%) residing in the Västerbotten region (Sweden), and the Österbotten region (Finland) in 2010. The associations between structural (measured by frequency of social contact with friends and neighbours) and cognitive (measured by experienced trust in friends and neighbours) aspects of social capital and depression (measured by Geriatric Depression Scale, GDS-4) were tested by logistic regression analyses. Results: Both low structural and cognitive social capital as defined in the study showed statistically significant associations with depression in older adults. Only experienced trust in neighbours failed to show significant association with depression. In addition, being single and being 80 years of age indicated a higher risk of depression as defined by GDS-4. Conclusion: The findings underline the connection between adequate levels of both structural and cognitive individual social capital and mental health in later life. They also suggest that the connection differs depending on various network types; the cognitive aspect of relationships between friends was connected to depression, while the connection was not found for neighbours. Further, the oldest age group in the sample (80 years of age) is pointed out as a population especially vulnerable for depression that should not be overlooked in mental health promotion and depression prevention.

The struggle versus the song – the local turn in peacebuilding: an introduction

This introduction presents how views on ‘the local turn’ in peacebuilding has evolved into a significant discourse. Currently, it has ‘its moment’ and is widely used by theorists and practitioners alike, by normative localists as well as by liberal policy-makers, albeit for different reasons and with differing intensions. We suggest that international interventions for the purpose of peacebuilding cannot be justified a priori, but requires resonance at the ‘receiving end’, which the local dimension potentially offers. It is however an elusive and contested concept that requires thorough scrutiny and critical assessment. Here a collection of conceptual and empirical articles is contextualised and introduced, painting a broad state-of-the-art of the pros and cons of the local turn.

Help-seeking behaviour, barriers to care and experiences of care among persons with depression in Eastern Cape, South Africa

BACKGROUND Little is known about the help-seeking behaviour and barriers to care among people with depression in poor resource settings in Sub-Saharan Africa. METHODS This is a cross-sectional population-based study including 977 persons aged 18-40 living in the Eastern Cape Province in South Africa. The prevalence of depression was investigated with the help of a questionnaire (the Mini International Neuropsychiatric Interview). Several socio-economic variables, statements on help-seeking and perceptions of earlier mental health care were included. Data collection was performed from March to July 2012. RESULTS The prevalence of depression was 31.4%. People aged 18-29 and those with no or low incomes were less likely to seek help. Promotive factors for help-seeking included having social support and tuberculosis comorbidity. Of all people with depression in this sample, 57% did not seek health care at all even though they felt they needed it. Of the variety of barriers identified, those of most significance were related to stigma, lack of knowledge of their own illness and its treatability as well as financial constraints. LIMITATION Recall bias may be present and the people identified with depression were asked if they ever felt so emotionally troubled that they felt they should seek help; however, we do not know if they had depression at the time they referred to. CONCLUSIONS Depression is highly prevalent among young adults in the Eastern Cape Province, South Africa; however, many do not seek help. Health planners should increase mental health literacy in the communities and improve the competence of the health staff.

Understanding the role of social capital for mental wellbeing among older adults

ABSTRACT Previous research applying quantifiable measurements has established significant positive associations between social capital and mental health in older adults. This study aimed to obtain a deeper understanding of the causal mechanisms of social capital affecting mental wellbeing among older people. The study is based on two independent qualitative data materials collected through two focus group interviews and an open-ended question included in a Finnish population-based postal survey. The findings indicate that informal social contacts such as family members and life-long relationships between friends impact the experienced mental wellbeing among older adults due to shared life events, social support, mutual appreciation and trust, as well as a sense of belonging through common social activities. Hence, this study challenges Putnams idea of social capital as a collective concept focusing on formal contacts and the benefits on a collective level. In addition, the findings highlight the obstacles specific to older adults in maintaining social networks and participation, which should be considered in order to promote mental health in later life.

Beyond the local turn divide: lessons learnt, relearnt and unlearnt

This article builds on the contributions to this special issue by examining different approaches to the local turn and what can be learnt from applying them. The contributors agree on the imperative of understanding ‘the local’ in peacebuilding; however, there seems to be a multitude of ways forward in this regard. The immediate concern is how this acknowledgement translates into practices that allow for both efficiency and local emancipation in the building of peace. The article suggests giving up the ‘one-size-fits-all’ model of peacebuilding and engaging in context-based methods and research designs beyond generalisations. One way to go about this is to strive for interdisciplinary research – combining peace studies and political science with social anthropologists and area studies – but also to involve ‘the locals’ themselves in the process of taking a few methodological steps further.

National policy in local practice: the case of Rwanda

Far reaching decentralisation reform has been launched in Rwanda, intended to contribute to socioeconomic development as well as to reconstruction and reconciliation. While the reform is well in line with the international trend of a ‘local turn’, the Rwandan government makes a point of not letting donors or other external actors set the agenda. Determined to formulate its own policies, thus claiming ‘national ownership’, it has, within the frame of decentralisation, launched several development programmes to be locally implemented and to promote local participation and downward accountability. However, the reform and programmes are designed and decided upon in a top-down manner by the central national leadership. This article analyses local experiences and perceptions of decentralisation and related programmes, and investigates whether and how such reform provides for local participation and downward accountability. It concludes that nationally owned reform is not necessarily an alternative to externally initiated and driven reform; neither local participation nor downward accountability was enhanced. The study builds on official policy documents and semi-structured interviews with Rwandan residents and local officials.

National ownership and donor involvement: an aid paradox illustrated by the case of Rwanda

Abstract A paradox in current international development cooperation is comprised by the simultaneous insistence on national ownership and far-reaching donor involvement through policy dialogue. In order to better understand this combination of a strong ownership ideal and extensive donor presence, this article explores how national and external actors portray the process of formulating and revising development policies and programmes in an aid recipient country. The study is based on original empirical material from national as well as external actors involved in the aid relation in Rwanda which, despite heavy aid dependence, is known to have achieved relative policy independence. Analysed in relation to three strands of critical thought in previous research, findings show that, in Rwanda, the very top political leadership is actively involved in initiating and formulating policies; that there are instances of negotiation as well as strong disagreements between national and external actors; and that, rather than donors seeking to retain control, Rwanda is depicted as setting its own agenda and effectively managing its donors. The paradox of an ownership ideal combined with donor involvement is thus met by an apparent tendency among national as well as external actors to emphasise national ownership while toning down donor influence.

Psychosocial interventions for prevention of depression in older people

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: 1. To assess the effectiveness of psychosocial interventions in primary prevention of depressive symptoms and unipolar depressive disorders in people over the age of 65. 2. The secondary objective is to separately assess the effectiveness of different forms of preventive interventions that have an impact on the social capital (i.e. social network, social support, trust, social participation) of participants.

Medicalization of sickness absence.

OBJECTIVE During the last decades, medical certificates have become the core administrative mechanism for a variety of redistributive policies within public administration. This article explores variations in sickness absence as a result of medicalization. METHODS The study focuses on the meaning of illness and work disability over time among physicians and the officials in the national insurance offices who are responsible for deciding on matters of sickness absence. 230 casebooks (including medical certificates) are included in the study. The material covers two time periods: the end of the 1970s and the end of the 1990s. RESULTS The findings indicate that over time officials and physicians have adopted a broader definition of illness and work disability. Different attention and meanings have been given to conditions and symptoms in the southern and northern parts of Sweden, resulting in a difference in diagnoses between the two regions. CONCLUSIONS The results indicate medicalization as one explanation for changing sickness figures and differences in the patterns of diagnoses, and the necessity of placing further emphasis on social insurance offices and their role in changing patterns of sickness absence.