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Clemente D, Romano L, Zamboni E, Carrus G, Panno A. Forest therapy using virtual reality in the older population: a systematic review. Front Psychol 2024; 14:1323758. [PMID: 38298360 PMCID: PMC10828037 DOI: 10.3389/fpsyg.2023.1323758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction As life expectancy increases, more attention needs to be paid to their mental and physical condition. Many older patients are also bedridden, which makes some treatments, like in vivo exposure to natural environments, more difficult to be applied. This study aimed to systematically review articles that include interventions combining virtual reality and forest environment, targeting a sample of older people. Methods Based on PRISMA guidelines, we conducted a literature search in three databases (EBSCO, PubMed, and Scopus), plus gray literature (OpenGrey). We considered only studies that used forest settings via virtual reality and included a sample with age ≥ 65. Results After the screening and eligibility stages, 7 articles have been included. Discussion The study underlines the need to implement research in this direction to standardize effective procedures that can be used to improve the mental and physical health of the older people and caregivers, while also reducing social costs.
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Affiliation(s)
- Davide Clemente
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Luciano Romano
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Elena Zamboni
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Giuseppe Carrus
- Department of Education Science, Roma Tre University, Rome, Lazio, Italy
| | - Angelo Panno
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
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2
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Lin S(L. Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada. J Gerontol B Psychol Sci Soc Sci 2023; 78:1555-1571. [PMID: 36842070 PMCID: PMC10461535 DOI: 10.1093/geronb/gbad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Indexed: 02/27/2023] Open
Abstract
OBJECTIVES Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment. METHODS Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC. RESULTS Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters. DISCUSSION To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.
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Affiliation(s)
- Shen (Lamson) Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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3
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Malhi GS, Bell E, Bassett D, Boyce P, Hopwood M, Mulder R, Porter R. Difficult decision-making in major depressive disorder: Practical guidance based on clinical research and experience. Bipolar Disord 2023; 25:355-378. [PMID: 37258062 DOI: 10.1111/bdi.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To extend current published guidance regarding the management of major depression in clinical practice, by examining complex cases that reflect real-world patients, and to integrate evidence and experience into recommendations. METHODS The authors who contributed to recently published clinical practice guidelines were invited to identify important gaps in extant guidance. Drawing on clinical experience and shared knowledge, they then generated four fictional case studies to illustrate the real-world complexities of managing mood disorders. The cases focussed specifically on issues that are not usually addressed in clinical practice guidelines. RESULTS The four cases are discussed in detail and each case is summarised using a life chart and accompanying information. The four cases reflect important real-world challenges that clinicians face when managing mood disorders in day-to-day clinical practice. To partly standardise the presentation of each case and for ease of reference we provide a Time Line, History Box and Management Chart, along with a synopsis where relevant. Discussion and formulation of the cases illustrate how to manage the complexities of each case and provide one possible pathway to achieving functional recovery. CONCLUSION These cases draw on the combined clinical experience of the authors and illustrate how to approach diagnostic decision-making when treating major depressive disorder and having to contend with complex presentations. The cases are designed to stimulate discussion and provide a real-world context for the formulation of mood disorders.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
| | - Darryl Bassett
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Victoria, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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4
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Rimmer RM, Costafreda SG, Mutz J, Joseph K, Brunoni AR, Loo CK, Padberg F, Palm U, Fu CH. Transcranial direct current stimulation effects in late life depression: A meta-analysis of individual participant data. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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5
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Amarti K, Schulte MHJ, Kleiboer A, Van Genugten CR, Oudega M, Sonnenberg C, Gonçalves GC, Rocha A, Riper H. Feasibility of Digital Cognitive Behavioral Therapy for Depressed Older Adults With the Moodbuster Platform: Protocol for 2 Pilot Feasibility Studies. JMIR Res Protoc 2022; 11:e41445. [PMID: 36282565 PMCID: PMC9644251 DOI: 10.2196/41445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Internet-based interventions can be effective in the treatment of depression. However, internet-based interventions for older adults with depression are scarce, and little is known about their feasibility and effectiveness. Objective To present the design of 2 studies aiming to assess the feasibility of internet-based cognitive behavioral treatment for older adults with depression. We will assess the feasibility of an online, guided version of the Moodbuster platform among depressed older adults from the general population as well as the feasibility of a blended format (combining integrated face-to-face sessions and internet-based modules) in a specialized mental health care outpatient clinic. Methods A single-group, pretest-posttest design will be applied in both settings. The primary outcome of the studies will be feasibility in terms of (1) acceptance and satisfaction (measured with the Client Satisfaction Questionnaire-8), (2) usability (measured with the System Usability Scale), and (3) engagement (measured with the Twente Engagement with eHealth Technologies Scale). Secondary outcomes include (1) the severity of depressive symptoms (measured with the 8-item Patient Health Questionnaire depression scale), (2) participant and therapist experience with the digital technology (measured with qualitative interviews), (3) the working alliance between patients and practitioners (from both perspectives; measured with the Working Alliance Inventory–Short Revised questionnaire), (4) the technical alliance between patients and the platform (measured with the Working Alliance Inventory for Online Interventions–Short Form questionnaire), and (5) uptake, in terms of attempted and completed modules. A total of 30 older adults with mild to moderate depressive symptoms (Geriatric Depression Scale 15 score between 5 and 11) will be recruited from the general population. A total of 15 older adults with moderate to severe depressive symptoms (Geriatric Depression Scale 15 score between 8 and 15) will be recruited from a specialized mental health care outpatient clinic. A mixed methods approach combining quantitative and qualitative analyses will be adopted. Both the primary and secondary outcomes will be further explored with individual semistructured interviews and synthesized descriptively. Descriptive statistics (reported as means and SDs) will be used to examine the primary and secondary outcome measures. Within-group depression severity will be analyzed using a 2-tailed, paired-sample t test to investigate differences between time points. The interviews will be recorded and analyzed using thematic analysis. Results The studies were funded in October 2019. Recruitment started in September 2022. Conclusions The results of these pilot studies will show whether this platform is feasible for use by the older adult population in a blended, guided format in the 2 settings and will represent the first exploration of the size of the effect of Moodbuster in terms of decreased depressive symptoms. International Registered Report Identifier (IRRID) PRR1-10.2196/41445
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Affiliation(s)
- Khadicha Amarti
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mieke H J Schulte
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Annet Kleiboer
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Claire Rosalie Van Genugten
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mardien Oudega
- Amsterdam Universitair Medisch Centrum, Vrije Universiteit, Public Health Research Institute and Neuroscience Amsterdam, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Caroline Sonnenberg
- Amsterdam Universitair Medisch Centrum, Vrije Universiteit, Public Health Research Institute and Neuroscience Amsterdam, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Gonçalo C Gonçalves
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Artur Rocha
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Heleen Riper
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
- Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
- Faculty of Medicine, University of Turku, Turku, Finland
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6
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Sharma D. Using developmental bibliotherapy design to improve self-management skills of post-graduate students. JOURNAL OF POETRY THERAPY 2022. [DOI: 10.1080/08893675.2022.2115696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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7
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Baba H, Kito S, Nukariya K, Takeshima M, Fujise N, Iga J, Oshibuchi H, Kawano M, Kimura M, Mizukami K, Mimura M. Guidelines for diagnosis and treatment of depression in older adults: A report from the Japanese Society of mood disorders. Psychiatry Clin Neurosci 2022; 76:222-234. [PMID: 35274788 DOI: 10.1111/pcn.13349] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
The Committee for Treatment Guidelines of Mood Disorders, Japanese Society of Mood Disorders, published a Japanese guideline for the treatment of late-life depression in 2020. Based on that guideline, the present guideline was developed and revised to incorporate the suggestions of global experts and the latest published evidence. In the diagnosis of late-life depression, it is important to carefully differentiate it from bipolar disorders, depressive states caused by physical and organic brain disease, drug effects, and dementia, and to determine the comorbidity between late-life depression and dementia. It is necessary to fully understand the clinical characteristics and psychosocial background of late-life depression, evaluate the patient's condition, and provide basic interventions based on these factors. Problem-solving therapy, reminiscence therapy/life review therapy, and behavioral activation therapy, and other forms of psychotherapy can reduce depressive symptoms. In terms of pharmacotherapy, newer antidepressants or non-tricyclic antidepressants are recommended for late-life depression, and it is recommended that the efficacy of least the minimal effective dosage should first be determined. Switching antidepressants and aripiprazole augmentation can be used to treatment-resistant therapy. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have demonstrated usefulness for late-life depression. Exercise therapy, high-intensity light therapy, and diet therapy also show some effectiveness and are useful for late-life depression. Continuation therapy should be maintained for at least 1 year after remission.
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Affiliation(s)
- Hajime Baba
- Department of Psychiatry, Juntendo University Koshigaya Hospital, Saitama, Japan.,Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Nukariya
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Minoru Takeshima
- Department of Psychiatry, Meishin-kai Shibata Hospital, Toyama, Japan.,Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Noboru Fujise
- Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Junichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.,Department of Child Psychiatry, Kanagawa Children's Medical Center, Kanagawa, Japan
| | | | - Mahiko Kimura
- Department of Neuropsychiatry, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
| | - Katsuyoshi Mizukami
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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8
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Weiskittle R, Tsang W, Schwabenbauer A, Andrew N, Mlinac M. Feasibility of a COVID-19 Rapid Response Telehealth Group Addressing Older Adult Worry and Social Isolation. Clin Gerontol 2022; 45:129-143. [PMID: 33870881 PMCID: PMC8522175 DOI: 10.1080/07317115.2021.1906812] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES During the early months of the COVID-19 pandemic, virtual and telephone visits rapidly replaced most in-person care within the Veterans Health Administration (VA) to reduce the virus spread. To address the emerging mental health needs of older Veterans (e.g., social isolation) in the context of chronic underlying mental health needs (e.g., trauma), we developed an 8-week virtual group treatment manual. This article describes the results from a survey of geriatric mental health clinicians who used the COVID group manual to determine its acceptability and feasibility in these settings. METHODS Clinicians across three VA integrated care settings (home-based primary care, community living centers, and geriatric primary care) were surveyed about their experiences implementing this treatment (n = 21). RESULTS Clinicians found this intervention to be effective with their patients and useful and adaptable beyond the early pandemic period. CONCLUSIONS This group teletherapy intervention was feasible and acceptable when treating Veterans in integrated geriatric healthcare settings. Despite technical challenges experienced by older Veterans, clinicians found this manual to be effective in addressing COVID-related worry and social isolation. CLINICAL IMPLICATIONS This rapid response manual has remained clinically useful in geriatric mental health care settings beyond the initial weeks of the pandemic.
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Affiliation(s)
- Rachel Weiskittle
- VA New England Geriatric Research Education and Clinical Center (GRECC).,VA Boston Healthcare System, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - William Tsang
- VDepartment of Psychology, William Paterson University, Wayne, NJ
| | | | | | - Michelle Mlinac
- VA Boston Healthcare System, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
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9
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Tasleem M, Alrehaily A, Almeleebia TM, Alshahrani MY, Ahmad I, Asiri M, Alabdallah NM, Saeed M. Investigation of Antidepressant Properties of Yohimbine by Employing Structure-Based Computational Assessments. Curr Issues Mol Biol 2021; 43:1805-1827. [PMID: 34889886 PMCID: PMC8929124 DOI: 10.3390/cimb43030127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/26/2022] Open
Abstract
The use of pharmaceuticals to treat Major Depressive Disorder (MDD) has several drawbacks, including severe side effects. Natural compounds with great efficacy and few side effects are in high demand due to the global rise in MDD and ineffective treatment. Yohimbine, a natural compound, has been used to treat various ailments, including neurological conditions, since ancient times. Serotonergic neurotransmission plays a crucial role in the pathogenesis of depression; thus, serotonergic receptor agonist/antagonistic drugs are promising anti-depressants. Yohimbine was investigated in this study to determine its antidepressant activity using molecular docking and pharmacokinetic analyses. Additionally, the in silico mutational study was carried out to understand the increase in therapeutic efficiency using site-directed mutagenesis. Conformational changes and fluctuations occurring during wild type and mutant serotonergic receptor, 5-hydroxytryptamine receptors 1A (5HT1A) and yohimbine were assessed by molecular dynamics MD simulation studies. Yohimbine was found to satisfy all the parameters for drug-likeness and pharmacokinetics analysis. It was found to possess a good dock score and hydrogen-bond interactions with wild type 5HT1A structure. Our findings elaborate the substantial efficacy of yohimbine against MDD; however, further bench work studies may be carried out to prove the same.
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Affiliation(s)
- Munazzah Tasleem
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu 610054, China
- Correspondence: (M.T.); (M.S.)
| | - Abdulwahed Alrehaily
- Department of Biology, Faculty of Science, Islamic University of Madinah, P.O. Box 170, Madinah 42351, Saudi Arabia;
| | - Tahani M. Almeleebia
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, P.O. Box 61413, Abha 62529, Saudi Arabia;
| | - Mohammad Y. Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 61413, Abha 62529, Saudi Arabia; (M.Y.A.); (I.A.); (M.A.)
| | - Irfan Ahmad
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 61413, Abha 62529, Saudi Arabia; (M.Y.A.); (I.A.); (M.A.)
| | - Mohammed Asiri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 61413, Abha 62529, Saudi Arabia; (M.Y.A.); (I.A.); (M.A.)
| | - Nadiyah M. Alabdallah
- Department of Biology, College of Science, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Mohd Saeed
- Department of Biology, College of Sciences University of Hail, P.O. Box 2440, Hail 2440, Saudi Arabia
- Correspondence: (M.T.); (M.S.)
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10
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Yuan Y, Lapane KL, Rothschild AJ, Ulbricht CM. Changes in depressive symptoms and cognitive impairment in older long-stay nursing home residents in the USA: a latent transition analysis. Aging Ment Health 2021; 25:1903-1912. [PMID: 33222506 PMCID: PMC8141058 DOI: 10.1080/13607863.2020.1849021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents. METHOD Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission. RESULTS Four latent statuses of depressive symptoms were identified: 'Multiple Symptoms' (prevalence at admission: 17.3%; 90 days: 13.6%), 'Depressed mood' (20.0%; 19.5%), 'Fatigue' (27.4%; 25.7%), and 'Minimal Symptoms' (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in 'Multiple Symptoms' and 'Fatigue' statuses; those with severe impairment had lower odds of belonging to 'Multiple Symptoms', 'Depressed Mood', and 'Fatigue' statuses. CONCLUSION By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.
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Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J. Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA, USA
| | - Christine M. Ulbricht
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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11
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Janis RA, Burlingame GM, Svien H, Jensen J, Lundgreen R. Group therapy for mood disorders: A meta-analysis. Psychother Res 2021; 31:342-358. [PMID: 32930060 DOI: 10.1080/10503307.2020.1817603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022] Open
Abstract
The addition of group psychotherapy as a specialty by the APA in 2018 creates a need for rigorous empirical reviews of group treatments for specific disorders. We conducted a meta-analysis of randomized controlled trials (RCTs) that tested the effect of group psychotherapy for mood disorders, including depression and bipolar disorder, at posttreatment and follow-up time-points, as well as rates of recovery and attrition. Major databases were searched for RCTs of group treatment for depression and bipolar disorder published from 1990 to 2018, which identified 42 studies across both disorders. Random effects meta-analyses indicated that group therapy for depression produced superior outcomes compared to waitlist control (WLC) and treatment as usual (TAU) and equivalent outcomes to medication. Similarly, group therapy for bipolar disorder produced superior outcomes to TAU. Analyses of recovery rates were conducted for depression, producing similar results to the main outcome analyses. Rates of attrition did not differ between group and comparison conditions for either disorder. These findings support group therapy for treating depression and bipolar disorder, although further research is needed comparing group treatment for bipolar disorder to medication.
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Affiliation(s)
- Rebecca A Janis
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | | | - Hal Svien
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Jennifer Jensen
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Rachel Lundgreen
- Department of Psychology, Brigham Young University, Provo, UT, USA
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12
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 244] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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Brouwer J, van den Berg F, Knooihuizen R, Loerts H, Keijzer M. Exploring Language Learning as a Potential Tool against Cognitive Impairment in Late-Life Depression: Two Meta-Analyses and Suggestions for Future Research. Behav Sci (Basel) 2020; 10:E132. [PMID: 32878051 PMCID: PMC7551097 DOI: 10.3390/bs10090132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
Late-life depression (LLD) affects about an eighth of community-dwelling seniors. LLD impacts well-being, with loneliness and small social networks being typical. It has also been linked to cognitive dysfunction and an increased risk of developing dementia. Safety and efficacy of pharmacological treatments for LLD have been debated, and cognitive dysfunction often persists even after remission. Various cognitive interventions have been proposed for LLD. Among these, one has received special attention: foreign language learning could serve as a social intervention that simultaneously targets brain structures affected in LLD. Lifelong bilingualism may significantly delay the onset of cognitive impairment symptoms by boosting cognitive reserve. Even late-life foreign language learning without lifelong bilingualism can train cognitive flexibility. It is then counterintuitive that the effects of language learning on LLD have never been examined. In order to create a theoretical basis for further interdisciplinary research, this paper presents a status quo of current work through two meta-analyses investigating cognitive functioning in LLD on the one hand and in senior bilinguals or seniors following a language course on the other hand. While LLD was consistently associated with cognitive dysfunction, inconsistent results were found for bilingualism and language learners. Possible reasons for this and suggestions for future research are subsequently discussed.
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Affiliation(s)
- Jelle Brouwer
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Floor van den Berg
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Remco Knooihuizen
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Hanneke Loerts
- Department of Minorities and Multilingualism, University of Groningen, 9712 EK Groningen, The Netherlands;
| | - Merel Keijzer
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
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14
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Rose-Clarke K, Pradhan I, Shrestha P, B K P, Magar J, Luitel NP, Devakumar D, Rafaeli AK, Clougherty K, Kohrt BA, Jordans MJD, Verdeli H. Culturally and developmentally adapting group interpersonal therapy for adolescents with depression in rural Nepal. BMC Psychol 2020; 8:83. [PMID: 32787932 PMCID: PMC7425581 DOI: 10.1186/s40359-020-00452-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence-based interventions are needed to reduce depression among adolescents in low- and middle-income countries (LMICs). One approach could be cultural adaptation of psychological therapies developed in high-income countries. We aimed to adapt the World Health Organization's Group Interpersonal Therapy (IPT) Manual for adolescents with depression in rural Nepal. METHODS We used a participatory, multi-stage adaptation process involving: translation and clinical review of the WHO Manual; desk reviews of adaptations of IPT in LMICs, and literature on child and adolescent mental health interventions and interpersonal problems in Nepal; a qualitative study to understand experiences of adolescent depression and preferences for a community-based psychological intervention including 25 interviews with adolescent boys and girls aged 13-18 with depression, four focus group discussions with adolescents, four with parents/caregivers and two with teachers, six interviews with community health workers and one with a representative from a local non-governmental organisation (total of 126 participants); training of IPT trainers and facilitators and practice IPT groups; and consultation with a youth mental health advisory board. We used the Ecological Validity Framework to guide the adaptation process. RESULTS We made adaptations to optimise treatment delivery and emphasise developmental and cultural aspects of depression. Key adaptations were: integrating therapy into secondary schools for delivery by school nurses and lay community members; adding components to promote parental engagement including a pre-group session with the adolescent and parent to mobilise parental support; using locally acceptable terms for mental illness such as udas-chinta (sadness and worry) and man ko samasya (heart-mind problem); framing the intervention as a training programme to de-stigmatise treatment; and including activities to strengthen relationships between group members. We did not adapt the therapeutic goals of IPT and conserved IPT-specific strategies and techniques, making edits only to the way these were described in the Manual. CONCLUSIONS Group IPT can be adapted for adolescents in Nepal and delivered through the education system. A randomised controlled trial is needed to assess the impact and costs of the intervention in this setting. Future research in LMICs to adapt IPT for adolescents could use this adapted intervention as a starting point.
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Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, WC2B 4BG, UK.
| | - Indira Pradhan
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Pragya Shrestha
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Prakash B K
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Alexandra Klein Rafaeli
- Psychological Services, Ruth and Allen Ziegler Student Services Division, Tel Aviv University, Tel Aviv, Israel
| | - Kathleen Clougherty
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, and Department of Global Health, George Washington University, Washington, DC, USA
| | - Mark J D Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
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15
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Xiang X, Wu S, Zuverink A, Tomasino KN, An R, Himle JA. Internet-delivered cognitive behavioral therapies for late-life depressive symptoms: a systematic review and meta-analysis. Aging Ment Health 2020; 24:1196-1206. [PMID: 30913898 PMCID: PMC7529149 DOI: 10.1080/13607863.2019.1590309] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: This study aimed to review and synthesize evidence related to the effectiveness of internet-based cognitive behavioral therapy (iCBT) for reducing depressive symptoms in older adults.Method: The authors conducted a systematic review of intervention studies testing iCBT for symptoms of depression in older adults. An initial search of PubMed, PsychINFO, and Web of Science was undertaken, followed by a manual search of reference lists of the relevant articles. The Cochrane Risk of Bias Tool was used to appraise study quality. The mean effect size for included studies was estimated in a random effects model. Meta-regression was used to examine potential moderators of effect sizes.Results: Nine studies met the inclusion criteria, including 1272 participants averaging 66 years of age. The study design included randomized controlled trials (k = 3), controlled trials without randomization (k = 2), uncontrolled trials (k = 2), and naturalistic evaluation (k = 2). Seven studies tested iCBT with some level of therapist involvement and 2 examined self-guided iCBT. Six studies tested interventions specifically adapted for older adults. The mean within-group effect size was 1.27 (95% CI = 1.09, 1.45) and the mean between-group effect size was 1.18 (95% CI = 0.63, 1.73). Participants' age was negatively associated with within-group effect sizes (b = -0.06, p = .016).Conclusions: iCBT is a promising approach for reducing depressive symptoms among older adults with mild to moderate depressive symptoms. However, studies involving older adults in iCBT trials were limited, had considerable heterogeneity, and were of low quality, calling for more studies with rigorous designs to produce a best-practice guideline.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Shiyou Wu
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Ashley Zuverink
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kathryn N. Tomasino
- Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois-Urbana Champaign, Champaign, IL, USA
| | - Joseph A. Himle
- School of Social Work, University of Michigan, Ann Arbor, MI, USA,Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, MI, USA
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Agüera-Ortiz L, Claver-Martín MD, Franco-Fernández MD, López-Álvarez J, Martín-Carrasco M, Ramos-García MI, Sánchez-Pérez M. Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association. Front Psychiatry 2020; 11:380. [PMID: 32508684 PMCID: PMC7251154 DOI: 10.3389/fpsyt.2020.00380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María Isabel Ramos-García
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Sánchez-Pérez
- Unidad de Psiquiatría Geriátrica, Hospital Sagrat Cor. Martorell, Barcelona, Spain
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17
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Abstract
AIMS The purpose of this review is to examine the replication attempts of psychotherapy clinical trials for depression and anxiety. We focus specifically on replications of trials that exhibit large differences between psychotherapies. The replicability of these trials is especially important for meta-analysis, where the inclusion of false-positive trials can lead to erroneous conclusions about treatment efficacy. METHODS Standard replication criteria were developed to distinguish direct from conceptual replication methodologies. Next, an exhaustive literature search was conducted for published meta-analyses of psychotherapy comparisons. Trials that exhibited large effects (d > 0.8) were culled from these meta-analyses. For each trial, a cited replication was conducted to determine if the trial had been subsequently replicated by either 'direct' or 'conceptual' methods. Finally, a broader search was conducted to examine the extent of replication efforts in the psychotherapy literature overall. RESULTS In the meta-analytic search, a total of N = 10 meta-analyses met the inclusion criteria. From these meta-analyses, N = 12 distinct trials exhibited large effect sizes. The meta-analyses containing more than two large effect trials reported evidence for treatment superiority. A cited replication search yielded no direct replication attempts (N = 0) for the trials with large effects, and N = 4 conceptual replication attempts of average or above average quality. However, of these four attempts, only two partially corroborated the results from their original trial. CONCLUSION Meta-analytic reviews are influenced by trials with large effects, and it is not uncommon for these reviews to contain several such trials. Since we find no evidence that trials with such large effects are directly replicable, treatment superiority conclusions from these reviews are highly questionable. To enhance the quality of clinical science, the development of authoritative replication criteria for clinical trials is needed. Moreover, quality benchmarks should be considered before trials are included in a meta-analysis, or replications are attempted.
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18
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Grover S, Avasthi A, Jagiwala M. Clinical Practice Guidelines for Practice of Supportive Psychotherapy. Indian J Psychiatry 2020; 62:S173-S182. [PMID: 32055060 PMCID: PMC7001359 DOI: 10.4103/psychiatry.indianjpsychiatry_768_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Jagiwala
- Consultant Psychiatrist, Brain Psycho Clinic, Surat, Gujarat, India
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19
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Whiston A, Bockting CLH, Semkovska M. Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder. Psychol Med 2019; 49:2657-2668. [PMID: 31615583 DOI: 10.1017/s0033291719002812] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Consistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies. METHODS PsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted. RESULTS In total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators. CONCLUSIONS Clinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.
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Affiliation(s)
- Aoife Whiston
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Claudi L H Bockting
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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20
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Guo Y, Chang SS, Chan CH, Chang Q, Hsu CY, Yip PSF. Association of neighbourhood social and physical attributes with depression in older adults in Hong Kong: a multilevel analysis. J Epidemiol Community Health 2019; 74:120-129. [DOI: 10.1136/jech-2019-212977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 11/04/2022]
Abstract
BackgroundPrevious studies investigating the independent effects of neighbourhood-level factors on depression are rare within the Asian context, especially in the elderly population.MethodsData for 29 099 older adults aged 65 years or above who have received health examinations at elderly health centres in Hong Kong in 2008–2011 were analysed. Using multilevel regression modelling, the cross-sectional associations of neighbourhood social attributes (neighbourhood poverty, ethnic minority, residential stability and elderly concentration) and physical (built) attributes (recreational services and walkability) with depression outcomes (depressive symptoms and depression) after adjusting for individual-level characteristics were investigated. Gender interaction effects were also examined.ResultsNeighbourhood poverty was associated with both depressive symptoms and depression in the elderly. Neighbourhood elderly concentration, recreational services and walkability were associated with fewer depressive symptoms. The association between neighbourhood poverty and elderly depressive symptoms was found in women only and not in men.ConclusionPolicies aimed at reducing neighbourhood poverty, increasing access to recreational services and enhancing walkability might be effective strategies to prevent depression in older adults in the urban settings.
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Krause M, Gutsmiedl K, Bighelli I, Schneider-Thoma J, Chaimani A, Leucht S. Efficacy and tolerability of pharmacological and non-pharmacological interventions in older patients with major depressive disorder: A systematic review, pairwise and network meta-analysis. Eur Neuropsychopharmacol 2019; 29:1003-1022. [PMID: 31327506 DOI: 10.1016/j.euroneuro.2019.07.130] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 01/01/2023]
Abstract
As there is currently no comprehensive evaluation about the efficacy and safety of interventions in elderly patients with major depressive disorder, we did a systematic review and network meta-analysis about all interventions in this population. We searched the specialised register of the Cochrane common mental disorders group, MEDLINE, EMBASE, PsycINFO, CochraneLibrary, ClinicalTrials.gov and the WHO registry until Dec 12, 2017 to identify all randomized controlled trials about the treatment of major depressive disorder in patients over an age of 65. The primary outcome was response defined as reduction of at least 50% on the Hamilton Depression Scale or any other validated depression scale. Secondary outcomes were remission, depressive symptoms, dropouts total, dropouts owing to inefficacy and dropouts due to adverse events, quality of life and social functioning. Additionally, we analysed 116 adverse events. We identified 129 references from 53 RCTs with 9274 participants published from 1990 to 2017. The mean participant age was 73.7 years. In terms of the primary outcome response to treatment the network-meta-analysis showed significant superiority compared to placebo for quetiapine and duloxetine; in addition, agomelatine, imipramine and vortioxetine outperformed placebo in pairwise meta-analyses, and there were also significant superiorities of several antidepressants compared to placebo in secondary efficacy outcomes. Very limited evidence suggests that competitive memory training, geriatric home treatment group and detached mindfulness condition reduce depressive symptoms. Several antidepressants and quetiapine have been shown to be efficacious in elderly patients with major depressive disorder, but due to the comparably few available data, the results are not robust. Differences in the multiple side-effects analysed should also be considered in drug choice. Although there were significant effects for some non-pharmacological treatments, the overall evidence for non-pharmacological treatments in major depressive disorder is insufficient, because it is based on a few trials with usually small sample sizes.
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Affiliation(s)
- Marc Krause
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany; Faculty of Medicine, Institute for Evidence in Medicine (for Cochrane Germany Foundation) Medical Center, University of Freiburg, Germany.
| | - Katharina Gutsmiedl
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
| | - Anna Chaimani
- Paris Descartes University, Paris, France; INSERM, UMR1153 Epidemiology and Statistics, Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris, France; Cochrane France, Paris, France
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675 Munich, Germany
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22
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Rossom RC, Simon GE, Coleman KJ, Beck A, Oliver M, Stewart C, Ahmedani B. Are wishes for death or suicidal ideation symptoms of depression in older adults? Aging Ment Health 2019; 23:912-918. [PMID: 29338321 PMCID: PMC6050135 DOI: 10.1080/13607863.2017.1423032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Clinicians may question whether thoughts of being better off dead are normal consequences of aging or symptoms of depression. We examine whether thoughts of suicide are as strongly linked to depression severity in older adults as they are in other age groups. METHODS Cross-sectional cohort study. Participants included 509,945 outpatients >18 years old from four large integrated healthcare systems in the Mental Health Research Network who completed 1.2 million Patient Health Questionnaires (PHQ) and had data to calculate Charlson Comorbidity Index scores from 2010 through 2012. The PHQ8 estimated depression severity, while suicidal ideation was measured using the 9th item of the PHQ. Data were abstracted from a Virtual Data Warehouse. RESULTS In older adult patients, suicidal ideation was strongly associated with depression severity. Older adults who had at least moderately-severe depression (PHQ8 ≥15) were 48 times more likely (95% CI: 42.8-53.8) to report suicidal ideation than those with minimal or mild symptoms of depression (PHQ8 <10) after adjustment for all other variables in the model, including medical comorbidity burden. CONCLUSIONS Depression severity was by far the strongest predictor of suicidal ideation in older adult patients. Older patients with suicidal ideation should be screened for depression.
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Affiliation(s)
- Rebecca C Rossom
- HealthPartners Institute, 8170 33rd Ave S, MS23301A, Minneapolis, MN. Phone: 952-883-5466
| | - Greg E Simon
- Kaiser Permanente Washington Health Research Institute, Minor Ave. #1600, Seattle, WA 98101. Phone: 206-287-2979
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation,100 S. Los Robles Ave, Pasadena, CA 91101. Phone: 626-564-3580
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, P.O. Box 378066, Denver, CO 80237-8066. Phone: 303-614-1326
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Minor Ave. #1600, Seattle, WA 98101. Phone: 206-287-2979
| | - Christine Stewart
- Kaiser Permanente Washington Health Research Institute, Minor Ave. #1600, Seattle, WA 98101. Phone: 206-287-2979
| | - Brian Ahmedani
- Henry Ford Health System, Behavioral Health Services and Center for Health Policy and Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 Detroit, MI. Phone: 313-874-5857
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Lapp M, Quadéri A, Corveleyn X. Effet de la thérapie des schémas sur la dépression de la personne âgée institutionnalisée : 3 études de cas uniques de type AB en lignes de bases multiples. PRAT PSYCHOL 2019. [DOI: 10.1016/j.prps.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tavares LR, Barbosa MR. Efficacy of group psychotherapy for geriatric depression: A systematic review. Arch Gerontol Geriatr 2018; 78:71-80. [PMID: 29933137 DOI: 10.1016/j.archger.2018.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/07/2018] [Accepted: 06/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Geriatric depression is a common and debilitating psychopathology, but evidence supports the efficacy of psychotherapy in its treatment. Group therapy provides advantages over individual interventions. However, only three systematic reviews have focused specifically on the efficacy of group therapy for geriatric depression. OBJECTIVE To ascertain the effects of group psychotherapy on geriatric depression in people aged 60 years and older, compared with alternative treatments or no treatment. DATA SOURCES A systematic review of English, Portuguese, and Spanish studies using the EBSCOhost Research and Science Direct databases (2011-2017). Additional studies were identified through reference lists. Search terms included group therapy, group psychotherapy, older adults, elderly, depressive disorder, geriatric depression, and depression in the elderly. REVIEW METHODS The researcher screened any study designs concerning the effects of any paradigm of group therapy on geriatric depression versus alternative interventions or no treatment. Relevant data, including indicators of risk of bias, were extracted. DATA SYNTHESIS Nine studies were reviewed. Reminiscence therapy and cognitive-behavioral therapy are viable group interventions for geriatric depression, and were significantly superior to most controls. Conclusions about the long-term effects were unclear. Significant improvements were obtained for different intervention durations and facilitators, and with participants of different nationalities and age. Most studies recruited participants from the community, which limited generalizability. Group therapy also resulted in improvements in other psychological variables. CONCLUSIONS Group therapy can significantly improve geriatric depression. Improvements were found across a variety of settings, protocols, participant characteristics, and for several psychological domains.
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Affiliation(s)
- L R Tavares
- Faculty of Psychology and Education Sciences, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal.
| | - M R Barbosa
- Center for Psychology at the University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal.
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Van Damme A, Declercq T, Lemey L, Tandt H, Petrovic M. Late-life depression: issues for the general practitioner. Int J Gen Med 2018; 11:113-120. [PMID: 29636629 PMCID: PMC5880181 DOI: 10.2147/ijgm.s154876] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Late-life depression (LLD) is both a prevalent and life-threatening disorder, affecting up to 13.3% of the elderly population. LLD can be difficult to identify because patients mainly consult their general practitioner (GP) for somatic complaints. Moreover, patients may be hesitant to express the problem to their GP. Increased vigilance on the part of the GP can only benefit older people with depression. To recognize the risk of LLD, screening tools are provided in addition to treatment options for LLD. This review aims to provide the GP with guidance in recognizing and treating LLD. It tries to connect mainstream etiologies of LLD (e.g., vascular, inflammation, hypothalamo-pituitary-adrenal axis) with risk factors and current therapies. Therefore, we provide a basis to the GP for decision-making when choosing an appropriate therapy for LLD.
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Affiliation(s)
- Axel Van Damme
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tom Declercq
- Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium
| | - Lieve Lemey
- Department of Psychiatry, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Hannelore Tandt
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Borza T, Benth JŠ, Helvik AS. Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies? Aging Ment Health 2018; 22:379-388. [PMID: 28051894 DOI: 10.1080/13607863.2016.1262817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Treatment of depression (in late life) is good. The short-term, but not long-term prognosis after treatment of depression in late life is good. To identify modifiable factors, we wanted to examine whether coping in terms of locus of control and coping strategies in depressed patients were associated with the prognosis of depression at follow-up, adjusted for sociodemographic information and health variables. METHOD In total, 122 patients (mean age 75.4 years; SD = 6.6) were followed up (median 13.7 months, Q1-Q3 386-441) with a diagnostic evaluation(ICD-10) for depression and assessment of depressive symptoms (MADRS). Coping was assessed using Locus of Control of behavior (LoC-scale) and Ways of Coping questionnaire (WoC-scale). RESULTS At follow-up, 37.7% were diagnosed with a depressive episode. A stronger external LoC and lower MMSE-NR score at baseline were in adjusted linear regression analysis significantly more associated to higher depressive symptom scores (MADRS). More use of problem-focused coping, a lower I-ADL functioning, but not emotion-focused coping at baseline were significantly associated with being depressed (ICD-10), at follow-up in adjusted logistic regression analysis. CONCLUSION LoC and coping strategies at baseline were associated with the prognosis of depression at follow-up, and may further be studied as indicators for choice of baseline intervention strategies.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental Health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway.,e National School of Public Health, Fundação Oswaldo Cruz , Rio , Brazil
| | - Deborah Bezerra Maia
- f Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU)
| | - Tom Borza
- d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway
| | - Jūratė Šaltytė Benth
- g St Olav's University Hospital , Trondheim , Norway.,h Institute of Clinical Medicine, Campus Ahus, University of Oslo , Norway
| | - Anne-Sofie Helvik
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,i HØKH, Research Centre , Akershus University Hospital , Norway
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M Williams C, Meeten F, Whiting S. 'I had a sort of epiphany!' An exploratory study of group mindfulness-based cognitive therapy for older people with depression. Aging Ment Health 2018; 22:208-217. [PMID: 27834499 DOI: 10.1080/13607863.2016.1247415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT. METHODS A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention. RESULTS Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people. CONCLUSION MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
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Affiliation(s)
| | - Frances Meeten
- a Sussex Partnership NHS Foundation Trust , UK.,b Clinical Imaging Sciences Centre, Brighton and Sussex Medical School , University of Sussex , Brighton , UK
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28
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Liew TM, Lee CS. Comparative efficacy and acceptability of interventions for major depression in older persons: protocol for Bayesian network meta-analysis. BMJ Open 2018; 8:e019819. [PMID: 29358451 PMCID: PMC5988061 DOI: 10.1136/bmjopen-2017-019819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Major depression is a leading cause of disability and has been associated with adverse effects in older persons. While many pharmacological and non-pharmacological interventions have been shown to be effective to address major depression in older persons, there has not been a meta-analysis that consolidates all the available interventions and compare the relative benefits of these available interventions. In this study, we aim to conduct a systematic review and network meta-analysis to compare the efficacy and acceptability of all the known pharmacological and non-pharmacological interventions for major depression in older persons. METHODS AND ANALYSIS We will search Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials and references of other review articles for articles related to the keywords of 'randomised trial', 'major depression', 'older persons' and 'treatments'. Two reviewers will independently select the eligible articles. For each included article, the two reviewers will independently extract the data and assess the risk of bias using the Cochrane revised tool for risk of bias. Bayesian network meta-analyses will be conducted to pool the depression scores (based on standardised mean difference) and the all-cause discontinuation across all included studies. The ranking probabilities for all interventions will be estimated and the hierarchy of each intervention will be summarised as surface under the cumulative ranking curve (SUCRA). Meta-regression and sub-group analyses will also be performed to evaluate the effect of study-level covariates. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION The results will be disseminated through conference presentations and peer-reviewed publications. They will provide the consolidated evidence to inform clinicians on the best choice of intervention to address major depression in older persons. PROSPERO REGISTRATION NUMBER CRD42017075756.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore
- Psychotherapy Unit, Institute of Mental Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore
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Hobbs MJ, Joubert AE, Mahoney AEJ, Andrews G. Treating late-life depression: Comparing the effects of internet-delivered cognitive behavior therapy across the adult lifespan. J Affect Disord 2018; 226:58-65. [PMID: 28963865 DOI: 10.1016/j.jad.2017.09.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The burden attributable to late-life depression is set to increase with the ageing population. The size of the workforce trained to deliver psychogeriatric medicine is limited. Internet-delivered cognitive behavioral therapy (iCBT) is an efficacious and scalable treatment option for depression. Yet older adults are underrepresented in iCBT research. This study examines the effects of iCBT for depression across the adult lifespan among patients seeking help in routine clinical care (N = 1288). METHODS Regression analyses were used to examine the relationship between age group (e.g., 18-24years (n = 141); 25-34years (n = 289); 35-44years (n = 320); 45-54years (n = 289); 55-64years (n = 180); 65 +years (n = 69)) and presenting demographic and clinical characteristics, adherence to treatment, and rates of remission, recovery and reliable improvement. Linear mixed models were used to examine whether reductions in symptom severity, distress and impairment varied as a function of age. RESULTS Patients aged 65+ years were more likely to be male compared to those aged 18-34 years and have been prescribed iCBT by their GP compared to those aged 55-64 years. Patients experiencing late-life depression experienced moderate to large effect size reductions in depressive symptom severity, psychological distress, and impairment, as did all other age groups. Rates of remission, recovery or reliable improvement were comparable across the adult lifespan. CONCLUSIONS iCBT is an effective treatment option for depression including in later life, and can be used to scale evidenced-based medicine in routine clinical care. LIMITATIONS No follow-up data were collected. The long-term effects of treatment, particularly for those who did not experience remission, are unclear.
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Affiliation(s)
- Megan J Hobbs
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Australia.
| | - Amy E Joubert
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Australia
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Cuijpers P, de Wit L, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis. Eur Psychiatry 2018; 48:27-37. [PMID: 29331596 DOI: 10.1016/j.eurpsy.2017.11.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Problem-solving therapy (PST) is one of the best examined types of psychotherapy for adult depression. No recent meta-analysis has examined the effects of PST compared to control groups or to other treatments. We wanted to verify whether PST is effective, whether effects are comparable to those of other treatments, and whether we could identify the possible sources of high heterogeneity that was found in earlier meta-analyses. METHODS We conducted systematic searches in bibliographical databases, including PubMed, PsycInfo, Embase and the Cochrane database of randomized trials. RESULTS We included 30 randomized controlled trials on PST (with 3530 patients), in which PST was compared to control conditions, with other therapies, and with pharmacotherapy. We could compare these 30 trials on PST also with 259 trials on other psychotherapies for adult depression. The effect size of PST versus control groups was g=0.79 (0.57-1.01) with very high heterogeneity (I2=84; 95% CI: 77-88). The effect size from the 9 studies with low risk of bias was g=0.34 (95% CI: 0.22-0.46) with low heterogeneity (I2=32; 95% CI: 0-68), which is comparable to the effects of other psychotherapies. PST was a little more effective than other therapies in direct comparisons, but that may be explained by the considerable number of studies with researcher allegiance towards PST. In meta-regression analyses of all controlled studies, no significant difference between PST and other therapies was found. CONCLUSION PST is probably an effective treatment for depression, with effect sizes that are small, but comparable to those found for other psychological treatments of depression.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands.
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - David D Ebert
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Stahl ST, Albert SM, Dew MA, Anderson S, Karp JF, Gildengers AG, Butters MA, Reynolds CF. Measuring Participant Effort in a Depression Prevention Trial: Who Engages in Problem-Solving Therapy? Am J Geriatr Psychiatry 2017; 25:909-916. [PMID: 28410857 PMCID: PMC5724523 DOI: 10.1016/j.jagp.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the acceptability of clinical interventions for depression prevention, identification of clinical characteristics associated with intervention engagement is needed. The purpose of this study is to describe levels and correlates of participant engagement in Problem Solving Therapy (PST) in adults 60 and older with subthreshold depression. METHODS As part of a clinical trial to prevent depression among older adults with subthreshold depression, participants who were randomized to receive PST completed 6-8 sessions in which they learned skills to solve self-selected problems that were contributing to stress and reduced quality of life. To measure participants' engagement with PST, interventionists completed 3 scales that rated participants' level of participation in problem solving activities, understanding of the multistep process of PST, and between-session homework effort. Using logistic regression, we examined whether physical health, level of cognitive function, gait speed, and disability served as correlates of engagement in the PST intervention. RESULTS Gait speed, a measure of physical and cognitive health, was significantly associated with engagement in PST. Participants who walked faster were more likely to engage with PST compared to participants who walked more slowly. No other baseline variables were significant correlates. CONCLUSIONS Older adults who walk more slowly may need alternative delivery methods to fully engage in PST. Gait speed reflects physical and cognitive health, and predicts frailty, disability, and psychomotor speed slowing. For these reasons, gait speed may be a marker for factors that will serve to predict poorer engagement in psychosocial interventions like PST.
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Sharpe L, McDonald S, Correia H, Raue PJ, Meade T, Nicholas M, Arean P. Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults. BMC Psychiatry 2017; 17:166. [PMID: 28472936 PMCID: PMC5418685 DOI: 10.1186/s12888-017-1334-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-morbidity in older adults is commonly associated with depressed mood. Similarly, subjective reports of pain are also associated with both physical illness and increased depressive symptoms. However, whether pain independently contributes to the experience of depression in older people with multi-morbidity has not been studied. METHODS In this study, participants were 1281 consecutive older adults presenting to one of 19 primary care services in Australia (recruitment rate = 75%). Participants were asked to indicate the presence of a number of common chronic illnesses, to rate their current pain severity and to complete the Geriatric Depression Scale. RESULTS Results confirmed that the number of medical illnesses reported was strongly associated with depressive symptoms. Twenty-six percent of participants with multi-morbidity scored in the clinical range for depressive symptoms in comparison to 15% of participants with no illnesses or a single illness. In regression analyses, the presence of chronic pain (t = 5.969, p < 0.0005), diabetes (t = 4.309, p < 0.0005), respiratory (t = 3.720, p < 0.0005) or neurological illness (t = 2.701, p = 0.007) were all independent contributors to depressive symptoms. Even when controlling for each individual illness, and the overall number of illnesses (t = 2.207, p = 0.028), pain severity remained an independent predictor of depressed mood (F change = 28.866, p < 0.0005, t = 5.373, p < 0.0005). CONCLUSIONS Physicians should consider screening for mood problems amongst those with multi-morbidity, particularly those who experience pain.
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Affiliation(s)
- Louise Sharpe
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Sydney, Australia
| | - Sarah McDonald
- 0000 0004 1936 834Xgrid.1013.3School of Psychology, University of Sydney, Sydney, Australia ,0000 0001 2158 5405grid.1004.5Department of Psychology, Macquarie University, Sydney, Australia
| | - Helen Correia
- 0000 0004 0436 6763grid.1025.6School of Psychology, Murdoch University, Perth, Australia
| | - Patrick J. Raue
- 0000000122986657grid.34477.33Psychiatry and Behavioral Sciences Division of Population Health, AIMS Centre University of Washington, Seattle, USA
| | - Tanya Meade
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, Australia. .,School of Medicine, University of Sydney, Sydney, Australia.
| | - Michael Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| | - Patricia Arean
- 0000000122986657grid.34477.33Psychiatry and Behavioral Sciences Division of Population Health, AIMS Centre University of Washington, Seattle, USA
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Stahl ST, Rodakowski J, Gildengers AG, Reynolds CF, Morse JQ, Rico K, Butters MA. Treatment Considerations for Depression Research in Older Married Couples: A Dyadic Case Study. Am J Geriatr Psychiatry 2017; 25:388-395. [PMID: 28237826 PMCID: PMC5724521 DOI: 10.1016/j.jagp.2016.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Critical gaps remain in understanding optimal approaches to intervening with older couples. The focus of this report is to describe the pros and cons of incorporating spousal dyads into depression-prevention research. METHODS In an intervention development study, the authors administered problem-solving therapy (PST) dyadically to participants with mild cognitive impairment (MCI) and their caregivers. Dyads worked with the same interventionist in the same therapy session. The dyadic PST (highlighted in a case example of a husband with MCI and his wife/support person) and the potential feasibility of the program are described. RESULTS The authors found that the wife of the individual with MCI could be trained as a PST coach to help her husband learn and use problem-solving skills. A decrease in depressive symptom severity was observed for the individual with MCI, which was sustained over 12 months of follow-up. Neither the husband nor wife experienced an incident episode of major depression over the course of the study. CONCLUSION Dyadic interventions need to be further developed in geriatric psychiatry; proven methods such as PST can be modified to include patients' support persons. Recommendations are offered for developing randomized controlled trials that aim to recruit dyads and prevent depression in at-risk older married couples.
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Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer Q Morse
- Department of Counseling Psychology, Chatham University, Pittsburgh, PA
| | - Kevin Rico
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Orique SB, Phillips LJ. The Effectiveness of Simulation on Recognizing and Managing Clinical Deterioration: Meta-Analyses. West J Nurs Res 2017; 40:582-609. [DOI: 10.1177/0193945917697224] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The purpose of these meta-analyses was to quantitatively synthesize the effectiveness of simulation on student nurses’ and registered nurses’ ability to recognize and manage clinical deterioration in the acute care setting. A search of the literature resulted in 22 reports and 19 studies meeting inclusion criteria. Four random-effects analyses were conducted to examine two-group posttest and single-group pre–posttest intervention effect sizes for knowledge and performance. A total of 41 effect sizes were calculated from the data extracted. The standardized mean difference ( d) for two-group posttest knowledge was d = 0.964 ( p = .001) and for performance was d = 1.382 ( p ≤ .001). The standardized mean difference for single-group pre–posttest knowledge was d = 1.231 ( p ≤ .001) and performance was d = 1.610 ( p ≤ .001). Findings indicate that simulation-based interventions have a positive effect on knowledge and performance. As simulation is increasingly used as a teaching modality in nursing, further research should aim to test standardized simulation-based education programs.
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Affiliation(s)
- Sabrina B. Orique
- University of Missouri, Columbia, MO, USA
- Kaweah Delta Health Care District, Visalia, CA, USA
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Green JS, Magee JC, Steiner ARW, Teachman BA. When the "Golden Years" Turn Blue: Using the Healthy Aging Literature to Elucidate Anxious and Depressive Disorders in Older Adulthood. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2017; 41:295-307. [PMID: 28503011 PMCID: PMC5425168 DOI: 10.1177/0165025415613855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current treatments for disorders of emotion, like pathological anxiety, are often less effective in older adults than in younger adults and have poorly understood mechanisms, pointing to the need for psychopathology models that better account for age-related changes in normative emotional functioning and the expression of disordered emotion. This article describes ways in which the healthy aging and emotion literature can enhance understanding and treatment of symptoms of anxiety and depression in later life. We offer recommendations for how to integrate the healthy aging literatures' theories and findings with psychopathology research and clinical practice, and highlight opportunities for future research.
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Conti EC, Stanley MA, Amspoker AB, Kunik ME. Sedative-Hypnotic Use Among Older Adults Participating in Anxiety Research. Int J Aging Hum Dev 2016; 85:3-17. [DOI: 10.1177/0091415016685330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Older adults are prescribed sedative-hypnotic medications at higher rates than younger adults. These are not recommended for older adults due to risk of sedation, cognitive impairment, and falls. Severe generalized anxiety disorder (GAD) is a possibly appropriate use of these medications in older people, but little is available on use of sedative-hypnotic medications among older adults with GAD. This study examined the frequency and predictors of sedative-hypnotic medication use among older adults screening positive for anxiety. 25.88% ( n = 125) of participants reported taking sedative-hypnotics over the past 3 months; 16.36% ( n = 79) reported taking benzodiazepines, and 12.22% ( n = 59) reported taking hypnotic sleep medications. Depressive symptoms were more strongly associated with sedative-hypnotic use than insomnia or worry. Major depressive disorder and posttraumatic stress disorder, but not GAD, predicted sedative-hypnotic use. Other medications and treatments are more appropriate and efficacious for depression, anxiety, and insomnia in this population.
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Affiliation(s)
- Elizabeth C. Conti
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Melinda A. Stanley
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Amber B. Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Mark E. Kunik
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
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Hummel J, Weisbrod C, Boesch L, Himpler K, Hauer K, Hautzinger M, Gaebel A, Zieschang T, Fickelscherer A, Diener S, Dutzi I, Krumm B, Oster P, Kopf D. AIDE-Acute Illness and Depression in Elderly Patients. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial. J Am Med Dir Assoc 2016; 18:341-349. [PMID: 27956074 DOI: 10.1016/j.jamda.2016.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression. OBJECTIVES To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness. DESIGN Randomized controlled trial with waiting list control group. SETTING Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients' homes. PARTICIPANTS A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness. INTERVENTION Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group. MEASUREMENTS HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician. RESULTS The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures. CONCLUSIONS CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients. CLINICAL TRIAL REGISTRATION www.germanctr.de German Trial Register DRKS 00004728.
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Affiliation(s)
- Jana Hummel
- Geriatric and Gerontopsychotherapeutic Practice, Mannheim, Germany.
| | | | | | | | - Klaus Hauer
- Geriatric Center Bethanien, Heidelberg, Germany
| | | | | | | | | | | | - Ilona Dutzi
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Bertram Krumm
- Central Institute of Mental Health, Mannheim, Germany
| | - Peter Oster
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Daniel Kopf
- Department of Geriatrics, Marien Hospital, Hamburg, Germany
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Zhao K, Bai ZG, Bo A, Chi I. A systematic review and meta-analysis of music therapy for the older adults with depression. Int J Geriatr Psychiatry 2016; 31:1188-1198. [PMID: 27094452 DOI: 10.1002/gps.4494] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the efficacy of music therapy in the management of depression in the elderly. METHOD We conducted a systematic review and meta-analysis of randomized controlled trials. Change in depressive symptoms was measured with various scales. Standardized mean differences were calculated for each therapy-control contrast. RESULTS A comprehensive search yielded 2,692 citations; 19 articles met inclusion criteria. Meta-analysis suggests that music therapy plus standard treatment has statistical significance in reducing depressive symptoms among older adults (standardized mean differences = 1.02; 95% CI = 0.87, 1.17). CONCLUSIONS This systematic review and meta-analysis suggests that music therapy has an effect on reducing depressive symptoms to some extent. However, high-quality trials evaluating the effects of music therapy on depression are required. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- K Zhao
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,The Second Clinic School, Lanzhou University, Lanzhou, China
| | - Z G Bai
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
| | - A Bo
- Silver School of Social Work, New York University, NY, USA
| | - I Chi
- School of Social Work, University of Southern California, LA, CA, USA
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Physical Activity Intervention Effects on Physical Function Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Aging Phys Act 2016; 25:149-170. [PMID: 27620705 DOI: 10.1123/japa.2016-0040] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of this systematic review and meta-analysis was to determine the effects of supervised resistance and/or aerobic training physical activity interventions on performance-based measures of physical functioning among community-dwelling older adults, and to identify factors impacting intervention effectiveness. Diverse search strategies were used to identify eligible studies. Standardized mean difference effect sizes (d, ES) were synthesized using a random effects model. Moderator analyses were conducted using subgroup analyses and meta-regression. Twenty-eight studies were included. Moderator analyses were limited by inconsistent reporting of sample and intervention characteristics. The overall mean ES was 0.45 (k = 38, p ≤ .01), representing a clinically meaningful reduction of 0.92 s in the Timed Up and Go for treatment versus control. More minutes per week (p < .01) and longer intervention session duration (p < .01) were associated with larger effects. Interventions were especially effective among frail participants (d = 1.09). Future research should clearly describe sample and intervention characteristics and incorporate frail populations.
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MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJV, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:588-603. [PMID: 27486149 PMCID: PMC4994788 DOI: 10.1177/0706743716659276] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section on "Special Populations" is the sixth of six guidelines articles. RESULTS Recent studies inform the treatment of MDD in children and adolescents, pregnant and breastfeeding women, women in perimenopause or menopause, and the elderly. Evidence for efficacy of treatments in these populations is more limited than for the general adult population, however, and risks of treatment in these groups are often poorly studied and reported. CONCLUSIONS Despite the limited evidence base, extant data and clinical experience suggest that each of these special populations can benefit from the systematic application of treatment guidelines for treatment of MDD.
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Affiliation(s)
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta
| | | | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Abstract
BACKGROUND This study compared sedative hypnotic use by type of mental health diagnosis and determined factors associated with use among older veterans (65+ years) with a newly reported mental health disorder. METHODS This study used data from veterans who received primary care services at VA Pittsburgh Healthcare System (VAPHS) from January 1, 2007 to December 31, 2011 (n = 879). RESULTS Sedative hypnotics were commonly used in older veterans within 12-months following a newly reported mental health disorder (19.9%), particularly amongst those with insomnia (41.7%). The number of newly reported mental health disorders was a significant factor associated with sedative hypnotic use, with the odds of use increasing by more than 200% in older adults with two newly reported disorders compared to those with one newly reported mental health disorder. CONCLUSIONS Continued efforts are needed to improve provider and patient awareness of the risks associated with sedative hypnotic use in older adults, as well as to increase access to and receipt of non-pharmacological mental health treatments for this vulnerable population.
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Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults. Int J Geriatr Psychiatry 2016; 31:526-35. [PMID: 26437368 DOI: 10.1002/gps.4358] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) affects many older adults and is associated with poor medical and mental health outcomes. Problem Solving Therapy (PST) has emerged as a promising psychotherapy for MDD in older adults, although the efficacy of PST in this population has not been well described. We examined the effectiveness of PST for the treatment of MDD in older adults in a systematic review and meta-analysis. METHODS We searched electronic databases to identify randomized controlled trials comparing PST to a control condition or other treatment for MDD in adults with an average age of 60 years or older. We used meta-analysis to arrive at pooled summary measures of the efficacy of PST when compared to control conditions on the change in depressive symptoms and other outcomes. RESULTS Nine studies with a total of 569 participants (290 PST, 279 control) met inclusion criteria. Most studies administered PST in person and were between 6 and 12 weeks in duration. Meta-analysis of six studies evaluating the effect of PST on depression using the Hamilton Rating Scale for Depression identified a significant reduction in depression associated with PST (pooled mean difference = -6.94, 95%CI -10.91 to -2.97, d = 1.15, P = 0.0006). PST was also effective in reducing disability in studies reporting this outcome. CONCLUSIONS Our review supports the existing research literature on PST suggesting that it is an effective treatment for older people with MDD. Further study is required to understand long-term outcomes associated with PST and its efficacy when compared to other treatments.
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Affiliation(s)
- Julia G Kirkham
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
| | - Namkee Choi
- School of Social Work, University of Texas at Austin, TX, USA
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
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Wuthrich VM, Rapee RM, Kangas M, Perini S. Randomized controlled trial of group cognitive behavioral therapy compared to a discussion group for co-morbid anxiety and depression in older adults. Psychol Med 2016; 46:785-795. [PMID: 26498268 DOI: 10.1017/s0033291715002251] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Co-morbid anxiety and depression in older adults is associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments in older adults. However, there is a paucity of research focused on testing the efficacy of the co-morbid treatment of anxiety and depression in older adults using psychological interventions. Accordingly, the primary objective of the current study was to test the effects of a group cognitive behavior therapy (CBT) program in treating co-morbid anxiety and depression in a sample of older age adults. METHOD A total of 133 community-dwelling participants aged ⩾60 years (mean age = 67.35, s.d. = 5.44, male = 59) with both an anxiety disorder and unipolar mood disorder, as assessed on the Anxiety Disorder Interview Schedule (ADIS), were randomly allocated to an 11-week CBT group or discussion group. Participants with Mini-Mental State Examination scores <26 were excluded. Participants were assessed pre-treatment, post-treatment and at 6 months follow-up on the ADIS, a brief measure of well-being, Geriatric Anxiety Inventory and Geriatric Depression Scale. RESULTS Both conditions resulted in significant improvements over time on all diagnostic, symptom and wellbeing measures. Significant group × time interaction effects emerged at post-treatment only for diagnostic severity of the primary disorder, mean severity of all anxiety disorders, mood disorders, and all disorders, and recovery rates on primary disorder. CONCLUSION Group CBT produced faster and sustained improvements in anxiety and depression on diagnostic severity and recovery rates compared to an active control in older adults.
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Affiliation(s)
- V M Wuthrich
- Department of Psychology,Centre for Emotional Health,Macquarie University,Sydney,Australia
| | - R M Rapee
- Department of Psychology,Centre for Emotional Health,Macquarie University,Sydney,Australia
| | - M Kangas
- Department of Psychology,Centre for Emotional Health,Macquarie University,Sydney,Australia
| | - S Perini
- Department of Psychology,Centre for Emotional Health,Macquarie University,Sydney,Australia
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Miloyan B, Pachana NA, Suddendorf T. Future-Oriented Thought Patterns Associated With Anxiety and Depression in Later Life: The Intriguing Prospects of Prospection. THE GERONTOLOGIST 2016; 57:619-625. [PMID: 26874188 DOI: 10.1093/geront/gnv695] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Anxiety and mood disorders in later life are the focus of an increasing amount of intervention research, however basic mechanisms and paradigms explaining etiology and maintenance warrant further exploration. Research on future-oriented thought patterns associated with anxiety and depression in this age group may prove useful, as these disorders are both characterized by a tendency to generate and fixate on threat-related future scenarios that may or may not materialize. Additionally, depression is associated with a reduced expectancy of positive future events. In this paper, we review the literature relevant to future thinking in anxiety and depression in older adults. We focus on the mental construction and anticipation of negative future events, and their underlying neurocognitive mechanisms. We then consider clinical and research implications of anxious and depressive future-oriented thought patterns for older adults. We believe that more research investigating future-oriented thought patterns associated with emotional disorders in later life could improve conceptualization, measurement, and perhaps potential treatments for late-life anxiety and depression.
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Affiliation(s)
- Beyon Miloyan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Thomas Suddendorf
- School of Psychology, The University of Queensland, Brisbane, Australia
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Design and Recruitment for a Randomized Controlled Trial of Problem-Solving Therapy to Prevent Depression among Older Adults with Need for Supportive Services. Am J Geriatr Psychiatry 2016; 24:94-102. [PMID: 26706911 PMCID: PMC4706765 DOI: 10.1016/j.jagp.2015.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Addressing subthreshold depression (indicated prevention) and vulnerabilities that increase the risk of major depression or anxiety disorders (selective prevention) is important for protecting mental health in old age. The Depression-Agency Based Collaborative (Dep-ABC) is a prevention trial involving older adults recruited from aging services sites (home care agencies, senior housing, senior centers) who meet criteria for subthreshold depression and disability. Therefore, the authors examine the effectiveness of partnerships with aging services sites for recruiting at-risk older adults, the quality of recruitment and acceptability of the Dep-ABC assessment and intervention, and the baseline status of participants. METHODS Dep-ABC is a single-blind randomized controlled prevention trial set in aging services settings but with centralized screening, randomization, in-home assessments, and follow-up. Its intervention arm involves six to eight sessions of problem-solving therapy, in which older adults aged 60+ learn to break down problems that affect well-being and develop strategies to address them. We examined participation rates to assess quality of recruitment across sites and level of disability according to service use. RESULTS Dep-ABC randomized 104 participants, 68.4% of eligible older adults. Screening using self-reported disability successfully netted a sample in which 74% received home care agency services, with remaining participants similarly impaired in structured self-reports of impairment and on observed performance tests. CONCLUSION Direct outreach to aging services providers is an effective way to identify older adults with service needs at high risk of major depression. Problem-solving therapy is acceptable to this population and can be added to current services.
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Heinzel S, Lawrence JB, Kallies G, Rapp MA, Heissel A. Using Exercise to Fight Depression in Older Adults. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2015. [DOI: 10.1024/1662-9647/a000133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Depression is the most prevalent psychiatric disorder in the general population. Despite a large demand for efficient treatment options, the majority of older depressed adults does not receive adequate treatment: Additional low-threshold treatments are needed for this age group. Over the past two decades, a growing number of randomized controlled trials (RCT) have been conducted, testing the efficacy of physical exercise in the alleviation of depression in older adults. This meta-analysis systematically reviews and evaluates these studies; some subanalyses testing specific effects of different types of exercise and settings are also performed. In order to be included, exercise programs of the RCTs had to fulfill the criteria of exercise according to the American College of Sports Medicine, including a sample mean age of 60 or above and an increased level of depressive symptoms. Eighteen trials with 1,063 participants fulfilled our inclusion criteria. A comparison of the posttreatment depression scores between the exercise and control groups revealed a moderate effect size in favor of the exercise groups (standardized mean difference (SMD) of –0.68, p < .001). The effect was comparable to the results achieved when only the eleven trials with low risk of bias were included (SMD = –0.63, p < .001). The subanalyses showed significant effects for all types of exercise and for supervised interventions. The results of this meta-analysis suggest that physical exercise may serve as a feasible, additional intervention to fight depression in older adults. However, because of small sample sizes of the majority of individual trials and high statistical heterogeneity, results must be interpreted carefully.
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Affiliation(s)
- Stephan Heinzel
- Social and Preventive Medicine, University of Potsdam, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Germany
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Germany
| | | | - Gunnar Kallies
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Germany
| | - Michael A. Rapp
- Social and Preventive Medicine, University of Potsdam, Germany
| | - Andreas Heissel
- Social and Preventive Medicine, University of Potsdam, Germany
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Djukanović I, Sorjonen K, Peterson U. Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden. Aging Ment Health 2015; 19:560-8. [PMID: 25266255 DOI: 10.1080/13607863.2014.962001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65-80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication. METHOD A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65-80 years (n = 6659). Chi square tests and logistic regression analyses were conducted. RESULTS The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75-80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits. CONCLUSION Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.
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Affiliation(s)
- Ingrid Djukanović
- a Department of Health and Caring Sciences , Linnaeus University , Kalmar , Sweden
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Blease CR. Talking more about talking cures: cognitive behavioural therapy and informed consent. JOURNAL OF MEDICAL ETHICS 2015; 41:750-755. [PMID: 25887514 DOI: 10.1136/medethics-2014-102641] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/20/2015] [Indexed: 06/04/2023]
Abstract
Cognitive behavioural therapy (CBT) has risen to prominence as an orthodox treatment option which is commonly recommended to patients with anxiety and depressive disorders. Mainstream healthcare institutions (including the National Health Service in the UK (NHS) and National Institute for Mental Health (NIMH)) assume that CBT works by helping patients to challenge and overcome 'faulty cognition'. Even if we accept the empirical evidence which shows that CBT (like other forms of psychotherapy) is a beneficial treatment there are still problems with this therapy: mainstream medicine and psychotherapy are continuing to ignore established research that CBT does not work according to its core theoretical tenets. This paper presents evidence that psychotherapy is entrenched in such conventional 'wisdom' and that practitioners are failing to meet their own codified requirement of informed consent. I examine ethical arguments for and against upholding current informed consent procedures and focus, in particular, on the relationship between respect for patient autonomy and the duty of beneficence. I argue that (so far) there are no strong grounds for the claim that patient autonomy undermines therapeutic outcome. The modest conclusion of this paper is that psychotherapy (including CBT) needs to begin to adapt informed consent procedures to comply with ongoing scientific research into its efficacy.
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One-Year Follow-Up of the Effectiveness of Cognitive Behavioral Group Therapy for Patients' Depression: A Randomized, Single-Blinded, Controlled Study. ScientificWorldJournal 2015; 2015:373149. [PMID: 26380359 PMCID: PMC4563093 DOI: 10.1155/2015/373149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/20/2014] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to investigate the long-term (one year) effectiveness of a 12-session weekly cognitive behavior group therapy (CBGT) on patients with depression. This was a single-blind randomized controlled study with a 2-arm parallel group design. Eighty-one subjects were randomly assigned to 12 sessions intervention group (CBGT) or control group (usual outpatient psychiatric care group) and 62 completed the study. The primary outcome was depression measured with Beck Depression Inventory (BDI-II) and Hamilton Rating Scale for Depression (HRSD). The secondary outcomes were automatic thoughts measured by automatic thoughts questionnaire (ATQ). Both groups were evaluated at the pretest (before 2 weeks), posttest (after 12 therapy sessions), and short- (3 months), medium- (6 months), and long-term (12 months) follow-up. After receiving CBGT, the experimental group had a statistically significant reduction in the BDI-II from 40.30 at baseline to 17.82 points at session eight and to 10.17 points at postintervention (P < 0.001). Similar effects were seen on the HRSD. ATQ significantly decreased at the 12th session, 6 months after sessions, and 1 year after the sessions ended (P < 0.001). We concluded that CBGT is effective for reducing depression and continued to be effective at 1 year of follow-up.
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Abstract
BACKGROUND Older adults with mental health disorders underutilize mental health services more than other adults. While there are well known general barriers to help seeking across the population, specific barriers for older adults include difficulties with transportation, beliefs that it is normal to be anxious and depressed in old age, and beliefs by referrers that psychological therapy is less likely to be effective. This study examined barriers related to identifying the need for help, seeking help and participating in therapy in a clinical population of older adults. METHOD Sixty older adults (aged 60-79 years) with comorbid anxiety and unipolar mood disorders completed barriers to treatment questionnaires before and after psychological group treatment, as well as measures of cognitive ability, anxiety, depression, and quality of life at baseline. RESULTS The greatest barriers to help seeking related to difficulties identifying the need for help, with 50% of the sample reporting their belief that their symptoms were normal as a major barrier. Other major barriers identified were related to: self-reliance, cost of treatment, and fear of medication replicating previous findings. The main barriers reported for difficulties in continuing therapy included not finding therapy helpful, cost of treatment, and thinking that the therapist did not understand their issues. CONCLUSIONS The main barriers identified related to issues with identifying the need to seek help. More attention is needed to educate older adults and professionals about the need for, and effectiveness of, psychological therapies for older adults with anxiety and depression to reduce this barrier to help seeking.
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