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La dépression est un problème répandu, sérieux, et souvent chronique chez lesaînés, qui sont souvent atteints de maladies physiques chroniques, et affecte de façonnégative leurs traitements et leurs soins. Malheureusement, le taux de détection et de suiviadéquat de la dépression est faible dans cette population. Au cours des deux dernièresdécennies, notre équipe a mené une série d’études pour mieux comprendre et améliorer lagestion de la dépression chez les aînés. Nous présentons une revue narrative et synthèse de25 articles qui incluent : 4 revues systématiques, 10 études observationnelles, 9 essaisd’interventions, et 2 conférences de consensus. Nous proposons en conclusion nosrecommandations pour 1) la détection de la dépression dans les soins de santé primaires ; 2)les soins collaboratifs de la dépression ; 3) des interventions d’autogestion de ladépression ; 4) le rôle des aidants naturels dans les interventions d’autogestion de ladépression.Objectives A research group based at St. Mary’s Research Centre,St. Mary’s Hospital, Montreal, has conducted a research program over the past two decadesthat aims to inform improvements in the management of depression in primary care and generalmedical settings, among older adults. This paper reviews the findings from this researchprogram, discusses the findings in the context of other research, and highlights theimplications for practice and health policy.Methods Narrative review and synthesis of 25 published articles,that included: 4 systematic reviews, 10 observational studies, 9 intervention trials, and 2consensus conference reports.Results The results pertain to 4 research areas: detection ofdepression in primary care and general medical settings; collaborative care of depression;depression self-care interventions; and the role of family and friends in supportingdepression self-care interventions.Conclusions We propose six recommendations for improving themanagement of depression in the target population. 1) Depression detection and treatment canbe improved through collaborative care models that involve primary care physicians, mentalhealth specialists and non-physician mental health workers who are trained to assist withthe detection of depression, with the delivery of brief, low-intensity psychologicalinterventions and with self-care support. More research and evaluation are necessary todetermine the factors that enhance the effectiveness, cost-efficiency, andconsumer-centeredness of these interventions. 2) Supported depression self-care (and otherlow-intensity interventions such as short problem-solving therapy) offered by telephone orvia internet, either as part of collaborative or usual care are feasible treatment optionsbut more research is necessary to determine their effectiveness in different clinicalpopulations. Some populations (e.g., those aged 75 and over, with visual and/or mildcognitive impairment) are likely to need greater or face-to-face support. 3) As most familyphysicians are unlikely to have the necessary time or interest to support depressionself-care interventions, other sustainable programmatic contexts are needed for delivery ofthese interventions. Options include: nurses or other mental health workers inmultidisciplinary family medicine groups; regional mental health programs; and voluntaryorganizations dedicated to assisting in the management of chronic illnesses. Research isneeded on the feasibility and effectiveness of using peer support workers or volunteers toprovide coaching of depression self-care interventions. 4) Involvement of family or friendsin depression self-care may improve outcomes (e.g., dyadic interventions) but furtherresearch is necessary. 5) Further research should explore the potential of depressionself-care interventions to prevent major depression and in depression relapse prevention inthis population

La gestion de la dépression chez les aînés et leurs aidants naturels : résultats d’un programme de recherche au Québec