Training Care Staff on Depression Screening & Referrals

It is estimated that less than half of depressed long-term care residents receive treatment for depression, which appears to affect approximately one in every 10 residents. Long-term care staff often fails to recognize symptoms of depression in residents, or mistakenly assumes that such symptoms are an inevitable response to aging or to residing in long-term care. An article in Aging & Mental Health reports on an assessment of an intervention to increase referrals for depression in long-term care.

Training programs that teach employees how to identify depression among older adults appear to be effective for improving employee knowledge about mental health, but little is known on how these programs affect the number of actual referrals and screenings. The study assessed the effectiveness of a protocol for the screening and referral of depression, in which long-term care staff were provided with explicit guidelines to screen residents for depression every two months, and to refer residents for treatment where appropriate.

The investigators randomly assigned seven long-term care sites to one of three conditions: a “training only” condition, in which employees were provided with educational training about depression; a “training-plus-protocol” condition, in which training was supplemented with the depression protocol, and a waitlist control group.

In each of the training and training-plus-protocol sites, just under half of nursing and other direct care staff attended the training program. (Attendance for the program was voluntary.) Investigators also recruited a total of 216 residents across the sites who agreed to allow researchers to audit any referral information. This allowed the investigators to compare the number of referrals across the different sites.

The training-only sites did not have significantly more referrals than the waitlist control sites, but the training-plus-protocol sites did see significantly more than either the training-only or the control sites. This was true for residents who had never received any prior treatment for depression as well as for those who had. This would suggest that training alone may be insufficient to increase depression referrals in long-term care, but that supplying direct care staff with screening and referral protocols might be effective

The study was unable to assess whether staff referrals for depression were accurate or appropriate, and the authors acknowledge that the relatively small sample of long-term care sites is a limitation of the study, suggesting the need for further research on such interventions.



Davison TE, Karantzas G, Mellor D, et al. Staff-focused interventions to increase referrals for depression in aged care facilities: a cluster randomized controlled trial. Aging & Mental Health (2013); 17(4): 449-455.

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