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Trotta A, Gerber AJ, Rost F, Robertson S, Shmueli A, Perelberg RJ. The efficacy of psychodynamic psychotherapy for young adults: a systematic review and meta-analysis. Front Psychol 2024; 15:1366032. [PMID: 39295759 PMCID: PMC11408295 DOI: 10.3389/fpsyg.2024.1366032] [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: 01/05/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024] Open
Abstract
Objective One in six young adults presents with at least one mental health problem. However, so far, little attention has been directed to the mental health needs and the efficacy of therapeutic interventions for young adults. We conducted a systematic review and meta-analysis of the type, quality and efficacy of psychoanalytic psychotherapy for young people. Method We searched the PsycInfo, PubMed, Embase, and Cochrane databases to identify all the published randomized controlled trials (RCT), and naturalistic and observational studies of psychodynamic or psychoanalytic psychotherapies. We calculated the standardized mean difference in scores of psychodynamic interventions versus control conditions, adopting a random effects model (Hedges' g). Results We identified 22 eligible studies, including 14 RCTs, and 8 naturalistic studies. Statistical analyses showed no significant difference between psychodynamic psychotherapy and other comparison treatments (psychotherapy or pharmacological interventions) for young adults (Hedges'g - 0.34 [95% CI: -0.991;-0.309], p = 0.304). Nevertheless, there was a significant effect of psychodynamic psychotherapy when compared with control conditions (waiting list or treatment as usual) for target symptoms (Hedges'g - 1.24 [95% CI: -1.97;-0.51], p < 0.001). Conclusion Our systematic review highlights important clinical implications in identifying the efficacy of psychoanalytic interventions for specific at-risk groups and suggests developing prevention strategies for mental health problems in young adulthood across cultures and context.
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Affiliation(s)
- Antonella Trotta
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- British Psychoanalytical Society, London, United Kingdom
| | - Andrew J Gerber
- Columbia University College of Physicians & Surgeons, New York, NY, United States
- Silver Hill Hospital, New Canaan, CT, United States
| | - Felicitas Rost
- School of Psychology and Psychotherapy, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, United Kingdom
| | | | - Avi Shmueli
- British Psychoanalytical Society, London, United Kingdom
| | - Rosine J Perelberg
- British Psychoanalytical Society, London, United Kingdom
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College, London, United Kingdom
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2
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Schmidt A, Grey N, Strauss C, Gaysina D. Predictors of treatment outcome of psychological therapies for common mental health problems (CMHP) in older adults: A systematic literature review. Clin Psychol Rev 2024; 112:102463. [PMID: 38968690 DOI: 10.1016/j.cpr.2024.102463] [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: 04/09/2022] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
Identifying factors that impact psychological treatment outcomes in older people with common mental health problems (CMHP) has important implications for supporting healthier and longer lives. The aim of the present study was to synthesise the evidence on predictors of psychological treatment outcomes in older people (aged 65+). PubMed, Scopus, Web of Science and PsycINFO were searched and 3929 articles were identified and screened, with 42 studies (N = 7978, M age = 68.9, SD age = 2.85) included: depression: k = 21, anxiety: k = 11, panic disorder: k = 3, mixed anxiety & depression: k = 3, PTSD: k = 2, various CMHP: k = 2, with CBT being the most common treatment (71%). The review identified 28 factors reported as significant predictors of treatment outcome in at least one study, across different domains: psychosocial (n = 9), clinical (n = 6), treatment-related (n = 6), socio-demographic (n = 4), neurobiological (n = 3). Homework completion was the most consistent predictor of positive treatment outcome. Baseline symptom severity was the most frequently studied significant predictor and across all conditions, with higher baseline symptom severity largely linked to worse treatment outcomes. No significant effects on treatment outcome were reported for gender, income and physical comorbidities. For a large majority of factors evidence was mixed or inconclusive. Further studies are required to identify factors affecting psychological treatment outcomes, which will be important for the development of personalised treatment approaches.
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Affiliation(s)
| | - Nick Grey
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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3
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Renn BN, Sams N, Areán PA, Raue PJ. A low-intensity behavioral intervention for depression in older adults delivered by lay coaches: proof-of-concept trial. Aging Ment Health 2023; 27:1403-1410. [PMID: 35694856 PMCID: PMC9741665 DOI: 10.1080/13607863.2022.2084709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A broader workforce is necessary to expand U.S. geriatric mental health services. We examined (1) feasibility of training undergraduate students to deliver Do More, Feel Better (DMFB), an evidence-informed program for depression; and (2) feasibility, acceptability, and outcomes in a single-arm proof-of-concept trial. METHOD In Study 1, we taught DMFB to 18 upper-level undergraduate students and assessed fidelity using role plays. In Study 2, four students delivered six weekly DMFB sessions to 12 community-dwelling older adults (M = 66.83 years old, SD = 10.39) with depression (PHQ ≥ 10). Patient outcomes were change in pre- to post-treatment depressive symptoms, disability, and the target mechanism of increased activity. RESULTS Fidelity was high in the course (Study 1; 82.4% of role plays rated as 'passing') and the trial (Study 2; 100% of 24 sessions rated as 'passing'). The majority (83.3%) of patients were retained and evidenced statistically and clinically significant improvement in depressive symptoms (Hamilton Rating Scale for Depression [HAM-D]), disability (World Health Organization's Disability Assessment Schedule 2.0 [WHODAS 2.0], and activity (Behavioral Activation for Depression Scale [BADS]). CONCLUSION It is feasible to train bachelor's-level students to deliver a brief, structured intervention for depression. Future research should consider implementation strategies and stakeholder feedback.
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Nichole Sams
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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4
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DeMarco EC, Zhang Z, Al-Hakeem H, Hinyard L. Depression After Parkinson's Disease: Treated Differently or Not At All? J Geriatr Psychiatry Neurol 2023; 36:39-51. [PMID: 35382620 DOI: 10.1177/08919887221090217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is a common, potentially debilitating non-motor symptom of Parkinson's disease which may manifest at any time and can respond to treatment. Although depression is a known primary mediator of health-related quality of life, it is currently unknown whether the timing of depression diagnosis relative to PD diagnosis affects receipt of depression treatment. Electronic health record data were examined to explore differences in depression treatment among patients diagnosed with depression before or after PD diagnosis. Compared to PD patients diagnosed with depression prior to PD, those diagnosed with depression following PD are less likely to receive any treatment, either pharmacologic or non-pharmacologic, indicating a temporal association between the time of PD diagnosis and receipt of depression treatment. This highlights a potentially substantial treatment gap, despite the existence of efficacious treatment. Diagnosis with PD appears to alter depression treatment and further research is warranted to determine potential causes and effective interventions.
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Affiliation(s)
- Elisabeth C DeMarco
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
| | - Zidong Zhang
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
| | - Haider Al-Hakeem
- 12274Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Leslie Hinyard
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
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Werson AD, Meiser-Stedman R, Laidlaw K. A meta-analysis of CBT efficacy for depression comparing adults and older adults. J Affect Disord 2022; 319:189-201. [PMID: 36113691 DOI: 10.1016/j.jad.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This meta-analysis investigates CBT treatment efficacy fordepression, and compares outcomes between adults (young and middle aged) and older adults (OA). METHODOLOGY Effect sizes (Hedges' g) were obtained from 37 peer-reviewed RCTs, 25 adult papers (participant n = 2948) and 12 OA papers (participant n = 551), and analysed with the random effects model. RESULTS No significant difference between age groups is reported in terms of CBT efficacy for depression compared to other treatments (Qbetween (1) = 0.06, p = .89), with the overall effect favouring CBT over any other treatments (g = 0.48, 95 % CI = 0.29-0.68). The same pattern of results was found when restricting studies to those which used active control conditions (Qbetween (1) = 0.03, p = .86) or passive control conditions (Q (1) = 2.45, p = .12). DISCUSSION No significant differences in efficacy for CBT treatment for depression are found when comparing adults and OA. CBT is as efficacious with OA as with adults.
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Affiliation(s)
- Alessa D Werson
- Norwich Medical School, University of East Anglia, United Kingdom; Department of Psychology: College of Life and Environmental Sciences, University of Exeter, United Kingdom.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, United Kingdom
| | - Ken Laidlaw
- Department of Psychology: College of Life and Environmental Sciences, University of Exeter, United Kingdom
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6
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Renn BN, Johnson M, Powers DM, Vredevoogd M, Unützer J. Collaborative care for depression yields similar improvement among older and younger rural adults. J Am Geriatr Soc 2021; 70:110-118. [PMID: 34536286 DOI: 10.1111/jgs.17457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depressive disorders are among the most prevalent mental health conditions; however, significant barriers to treatment access persist. This study examined differences in depression outcomes between younger and older adults in a large-scale implementation demonstration of the collaborative care model (CoCM). METHODS Secondary data analysis of a longitudinal, observational implementation demonstration at eight primary care clinics across low-resourced rural or frontier areas of the Western United States. Seven of these clinics were federally qualified health centers. The sample consisted of 3722 younger (18-64 years) and older (65+ years) adult primary care patients diagnosed with unipolar depression. All participants received depression treatment via CoCM, which enhances usual primary care and makes efficient use of specialists by using a behavioral healthcare manager and a psychiatric consultant to support primary care providers. Clinics were followed for up to 27 months. Patients were followed until they completed treatment or dropped out. The Patient Health Questionnaire (PHQ-9) assessed depressive symptoms at baseline (enrollment) and at most follow-up contacts. The primary treatment outcome was a change between a patient's first and last recorded PHQ-9 scores. RESULTS Across both age groups, there was an average overall reduction of 6.9 points on the PHQ-9. Older adults demonstrated a greater decrease in depression scores of 2.06 points (95% CI -2.98 to -1.14, p < 0.001) on the PHQ-9 compared with younger adults. Estimates were robust when adjusting for gender, race, and clinic. CONCLUSIONS CoCM resulted in meaningful improvement in depressive symptoms across age groups.
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Diane M Powers
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mindy Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Lazarus G, Fisher AJ. Negative Emotion Differentiation Predicts Psychotherapy Outcome: Preliminary Findings. Front Psychol 2021; 12:689407. [PMID: 34408708 PMCID: PMC8366397 DOI: 10.3389/fpsyg.2021.689407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Emotion differentiation (ED), the extent to which same-valenced emotions are experienced as distinct, is considered a valuable ability in various contexts owing to the essential affect-related information it provides. This information can help individuals understand and regulate their emotional and motivational states. In this study, we sought to examine the extent to which ED can be beneficial in psychotherapy context and specifically for predicting treatment response. Thirty-two prospective patients with mood and anxiety disorders completed four daily assessments of negative and positive emotions for 30 days before receiving cognitive-behavioral treatment. Depression, stress, and anxiety symptoms severity were assessed pre- and post-treatment using self-reports and clinical interviews. We conducted a series of hierarchical regression models in which symptoms change scores were predicted by ED while adjusting for the mean and variability. We found that negative ED was associated with greater self-reported treatment response (except for anxiety) when negative emotional variability (EV) was included in the models. Probing negative ED and EV's interactive effects suggested that negative ED was associated with greater treatment response (except for anxiety) for individuals with lower EV levels. Results were obtained while controlling for mean negative affect. Our findings suggest that negative ED can benefit psychotherapy patients whose negative emotions are relatively less variable. We discuss the meaning of suppression and interactive effects between affect dynamics and consider possible clinical implications.
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Affiliation(s)
- Gal Lazarus
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
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O’Donnell J, Pybis J, Bacon J. Counselling in the third sector: to what extent are older adults accessing these services and how complete are the data third sector services collect measuring client psychological distress? COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer O’Donnell
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
| | - Joanne Pybis
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
| | - Jeremy Bacon
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
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9
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von Eitzen L, Valerius K, van den Berg N, Völzke H, Grabe HJ, Schomerus G, Speerforck S. [Sociodemographic and Disorder-Specific Determinants for Professional Help-seeking due to Depression in a Structurally Weak Region - The Important Role of Age]. PSYCHIATRISCHE PRAXIS 2021; 48:404-411. [PMID: 34015855 DOI: 10.1055/a-1468-3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Study of sociodemographic and disorder-specific determinants of professional help-seeking in lifetime depression. METHODS In the population-based SHIP-Trend-1 study (2016-2019), we assessed N = 490 adults with lifetime depression and their help-seeking behaviour. Gender, socioeconomic status and disorder-specific variables were implemented in age-stratified logistic regression models. RESULTS Men and older adults at the time of the survey sought less help than women and younger people. In the younger and middle age group severity level was associated with professional help-seeking, in the older age group professional help-seeking was more prevalent in case of physical causes for the depression. CONCLUSION We found age-specific differences in the determinants for professional help-seeking. Latent variables like age-specific experiences, values, and life styles may explain those differences.
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Affiliation(s)
- Linnéa von Eitzen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Karsten Valerius
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | | | - Henry Völzke
- Institut für Community Medicine, Universitätsmedizin Greifswald
| | - Hans J Grabe
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Greifswald.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Greifswald/Rostock, Standort Greifswald
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Sven Speerforck
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
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10
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Lin SM, Borges MK, de Siqueira ASS, Biella MM, Jacob-Filho W, Cesari M, Voshaar RCO, Aprahamian I. Serotonin receptor inhibitor is associated with falls independent of frailty in older adults. Aging Ment Health 2021; 25:219-224. [PMID: 31603040 DOI: 10.1080/13607863.2019.1675143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. METHODS Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. RESULTS At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. CONCLUSION SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.
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Affiliation(s)
- Sumika M Lin
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcus K Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alaise S S de Siqueira
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marina M Biella
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedadale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Richard C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ivan Aprahamian
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.,Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
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Guo T, Su J, Hu J, Aalberg M, Zhu Y, Teng T, Zhou X. Individual vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2021; 12:674267. [PMID: 34744809 PMCID: PMC8564073 DOI: 10.3389/fpsyt.2021.674267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anxiety disorder is the most prevalent mental disorder in children and adolescents. However, evidence for efficacy and acceptability between individual cognitive behavior therapy (I-CBT) and group cognitive behavior therapy (G-CBT) in anxiety disorders in children and adolescents remains unclear. Methods: Eight electronic databases (PubMed, Embase, Cochrane, Web of Science, CINAHL, PsycINFO, ProQuest, and LILACS) were searched from inception to October 2019. Randomized controlled trials comparing I-CBT with G-CBT for anxiety disorders in children and adolescents were included. The primary outcomes were efficacy (mean change in anxiety symptom scores) at post-treatment and acceptability (all-cause discontinuation). The secondary outcome was remission at post-treatment. Subgroup analyses were also conducted to examine whether the result would be influenced by age, number of treatment sessions, parental involvement, male/female sex, and number of participants. Results: Nine studies were selected in this meta-analysis. The pooled analyses indicated no significant difference between I-CBT and G-CBT for efficacy at post-treatment [standardized mean difference (SMD), -0.14; 95% confidence interval (CI), -0.37 to 0.09], acceptability [odds ratio (OR), 1.30; 95% CI, 0.61-2.77], and remission at post-treatment (OR, 1.15; 95% CI, 0.79-1.66). In the subgroup analysis of age, I-CBT was significantly more effective than G-CBT in adolescents at post-treatment (SMD, -0.77; 95% CI, -1.51 to -0.02), but not in children (SMD, 0.00; 95% CI, -0.02 to 0.20). However, the findings were not materially different from those of the efficacy subgroup analysis of number of treatment sessions, parental involvement, male/female sex, and number of participants. Conclusions: Based on those current evidence, I-CBT was shown to be more beneficial than G-CBT for anxiety disorders in adolescents, but not in children. However, further well-designed clinical studies should be performed to confirm these findings. Systematic Review Registration:http://osf.io/xrjkp, identifier: 10.17605/OSF.IO/XRJKP.
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Affiliation(s)
- Tingting Guo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,The First Clinical College of Chongqing Medical University, Chongqing, China
| | - Jing Su
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,The Second Clinical College of Chongqing Medical University, Chongqing, China
| | - Jiayi Hu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,The Second Clinical College of Chongqing Medical University, Chongqing, China
| | - Marianne Aalberg
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Yinglin Zhu
- School of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Joplin, MO, United States
| | - Teng Teng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Cuijpers P, Karyotaki E, Eckshtain D, Ng MY, Corteselli KA, Noma H, Quero S, Weisz JR. Psychotherapy for Depression Across Different Age Groups: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:694-702. [PMID: 32186668 PMCID: PMC7081149 DOI: 10.1001/jamapsychiatry.2020.0164] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE It is not clear whether psychotherapies for depression have comparable effects across the life span. Finding out is important from a clinical and scientific perspective. OBJECTIVE To compare the effects of psychotherapies for depression between different age groups. DATA SOURCES Four major bibliographic databases (PubMed, PsychINFO, Embase, and Cochrane) were searched for trials comparing psychotherapy with control conditions up to January 2019. STUDY SELECTION Randomized trials comparing psychotherapies for depression with control conditions in all age groups were included. DATA EXTRACTION AND SYNTHESIS Effect sizes (Hedges g) were calculated for all comparisons and pooled with random-effects models. Differences in effects between age groups were examined with mixed-effects subgroup analyses and in meta-regression analyses. MAIN OUTCOMES AND MEASURES Depressive symptoms were the primary outcome. RESULTS After removing duplicates, 16 756 records were screened and 2608 full-text articles were screened. Of these, 366 trials (36 702 patients) with 453 comparisons between a therapy and a control condition were included in the qualitative analysis, including 13 (3.6%) in children (13 years and younger), 24 (6.6%) in adolescents (≥13 to 18 years), 19 (5.2%) in young adults (≥18 to 24 years), 242 (66.1%) in middle-aged adults (≥24 to 55 years), 58 (15.8%) in older adults (≥55 to 75 years), and 10 (2.7%) in older old adults (75 years and older). The overall effect size of all comparisons across all age groups was g = 0.75 (95% CI, 0.67-0.82), with very high heterogeneity (I2 = 80%; 95% CI: 78-82). Mean effect sizes for depressive symptoms in children (g = 0.35; 95% CI, 0.15-0.55) and adolescents (g = 0.55; 95% CI, 0.34-0.75) were significantly lower than those in middle-aged adults (g = 0.77; 95% CI, 0.67-0.87). The effect sizes in young adults (g = 0.98; 95% CI, 0.79-1.16) were significantly larger than those in middle-aged adults. No significant difference was found between older adults (g = 0.66; 95% CI, 0.51-0.82) and those in older old adults (g = 0.97; 95% CI, 0.42-1.52). The outcomes should be considered with caution because of the suboptimal quality of most of the studies and the high levels of heterogeneity. However, most primary findings proved robust across sensitivity analyses, addressing risk of bias, target populations included, type of therapy, diagnosis of mood disorder, and method of data analysis. CONCLUSIONS AND RELEVANCE Trials included in this meta-analysis reported effect sizes of psychotherapies that were smaller in children than in adults, probably also smaller in adolescents, that the effects may be somewhat larger in young adults, and without meaningful differences between middle-aged adults, older adults, and older old adults.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Dikla Eckshtain
- Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston
| | - Mei Yi Ng
- Department of Psychology and Center for Children and Families, Florida International University, Miami
| | | | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - John R. Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts
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13
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Bilbrey AC, Laidlaw K, Cassidy-Eagle E, Thompson LW, Gallagher-Thompson D. Cognitive Behavioral Therapy for Late-Life Depression: Evidence, Issues, and Recommendations. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Borglin G, Räthel K, Paulsson H, Sjögren Forss K. Registered nurses experiences of managing depressive symptoms at care centres for older people: a qualitative descriptive study. BMC Nurs 2019; 18:43. [PMID: 31516384 PMCID: PMC6728937 DOI: 10.1186/s12912-019-0368-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/29/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Depressive symptoms and/or depression are commonly experienced by older people. Both are underdiagnosed, undertreated and regularly overlooked by healthcare professionals. Healthcare facilities for people aged ≥75 years have been in place in Sweden since 2015. The aim of these care centres, which are managed by registered nurses (RNs), is to offer care adjusted to cater to the complex needs and health problems of older people. Although the mental health of older people is prioritised in these centres, research into the experience of RNs of depressive symptoms and/or depression in older people in this setting is limited. Therefore, this study aimed to illuminate RNs, working at care centres for older people, experience of identifying and intervening in cases of depressive symptoms. METHODS The data for this qualitative descriptive study were collected through interviews (n = 10) with RNs working at 10 care centres for older people in southern Sweden. The transcribed texts were analysed using inductive content analysis. RESULTS The participants' experiences could be understood from four predominant themes: (1) challenging to identify, (2) described interventions, (3) prerequisites for identification, and (4) contextual influences. Key findings were that it was difficult to identify depression as it often manifested as physical symptoms; evidence-based nursing interventions were generally not the first-line treatment used; trust, continuity and the ability of RNs to think laterally; and the context influenced the ability of RNs to manage older people's depressive symptoms and/or depression. CONCLUSIONS The process of identifying depressive symptoms and performing an appropriate intervention was found to be complex, especially as older people were reluctant to present at the centres and provided obscure reasons for doing so. A nurse-patient relationship that was built on trust and was characterised by continuity of care was identified as a necessary prerequisite. Appropriate nursing interventions-afforded the same status as pharmacological treatment-are warranted as the first-line treatment of depression. Further research is also needed into efficacious nursing interventions targeting depressive symptoms and/or depression.
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Affiliation(s)
- Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
- Department of Nursing Education, Lovisenberg Diaconal University College, 0456 Oslo, Norway
| | - Kristina Räthel
- Department of Geriatric, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Helena Paulsson
- Åstorp Primary Care Centre, Region Skåne, SE-265 34 Åstorp, Sweden
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
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Cuijpers P, Karyotaki E, de Wit L, Ebert DD. The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review. Psychother Res 2019; 30:279-293. [DOI: 10.1080/10503307.2019.1649732] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David D. Ebert
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD. J Anxiety Disord 2019; 64:45-54. [PMID: 30978622 DOI: 10.1016/j.janxdis.2019.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although prolonged exposure (PE) has strong support for treating posttraumatic stress disorder (PTSD), there is little research on PE for older adults. Likewise, Relaxation Training (RT) has shown some benefit for PTSD, but has not been adequately tested in this population. METHOD This study represents the first randomized controlled trial of two active psychotherapies for PTSD among older adults. Male combat veterans (N = 87; mean age = 65 years) were randomly assigned to 12 sessions of PE (n = 41) or RT (n = 46). Clinician-administered and self-report assessments were conducted at pre-treatment, post-treatment, and six-month follow-up; self-reported symptoms were also measured at each treatment session. RESULTS Multi-level modeling indicated that Clinician-Administered PTSD Scale scores significantly decreased from pre-treatment to follow-up, but the time by treatment condition interaction was not significant. Pre- to post-treatment change was large in PE and moderate in RT, but many gains were lost at follow-up. For self-reported PTSD symptoms, a significant time by treatment condition interaction emerged, suggesting that participants who received PE had both greater decreases in symptoms and a greater rebound in self-reported PTSD symptoms than those who received RT. Unlike PTSD symptoms, depression symptoms neither changed nor were moderated by treatment condition from pre-treatment to follow-up. For self-reported PTSD and depression symptoms assessed at each session, time significantly predicted symptom reductions across psychotherapy sessions. CONCLUSIONS PE and RT are well-tolerated, feasible, and effective for older adults, though treatment gains were not maintained at follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00539279.
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Vitinius F, Escherich S, Deter HC, Hellmich M, Jünger J, Petrowski K, Ladwig KH, Lambertus F, Michal M, Weber C, de Zwaan M, Herrmann-Lingen C, Ronel J, Albus C. Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study. BMC Psychiatry 2019; 19:57. [PMID: 30717711 PMCID: PMC6360727 DOI: 10.1186/s12888-019-2026-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD. METHODS Based on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach. RESULTS Higher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results. CONCLUSION Our findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors. TRIAL REGISTRATION www.clinicaltrials.gov NCT00705965 (registered 27th of June, 2008). www.isrctn.com ISRCTN76240576 (registered 27th of March, 2008).
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Affiliation(s)
- Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany.
| | - Steffen Escherich
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
| | - Hans-Christian Deter
- grid.412753.6Department of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martin Hellmich
- 0000 0000 8580 3777grid.6190.eInstitute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Jana Jünger
- German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Katja Petrowski
- 0000 0001 2111 7257grid.4488.0Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Karl-Heinz Ladwig
- German Research Center of Environmental Health, Helmholtz Zentrum Muenchen, Institute of Epidemiology, Oberschleißheim, Germany
| | - Frank Lambertus
- 0000 0000 8580 3777grid.6190.eDepartment of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Matthias Michal
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Mainz, Mainz, Germany
| | - Cora Weber
- grid.412753.6Department of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martina de Zwaan
- 0000 0000 9529 9877grid.10423.34Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christoph Herrmann-Lingen
- 0000 0001 2364 4210grid.7450.6Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - Joram Ronel
- 0000000123222966grid.6936.aDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Universitaet München, Munich, Germany
| | - Christian Albus
- 0000 0000 8580 3777grid.6190.eDepartment of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
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Schneider BC, Schröder J, Berger T, Hohagen F, Meyer B, Späth C, Greiner W, Hautzinger M, Lutz W, Rose M, Vettorazzi E, Moritz S, Klein JP. Bridging the "digital divide": A comparison of use and effectiveness of an online intervention for depression between Baby Boomers and Millennials. J Affect Disord 2018; 236:243-251. [PMID: 29751239 DOI: 10.1016/j.jad.2018.04.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/13/2018] [Accepted: 04/08/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Psychological online interventions (POIs) for depression have demonstrated promising effects. However, there are fewer randomized controlled studies on POIs among older adults with depression. The goal of the present study was to compare the use and efficacy of Deprexis, an online intervention for depression, among Millennials (18-35 years) and Baby Boomers (50-65 years). METHODS We completed a secondary data analysis on a subset (N = 577) of participants in the EVIDENT trial, a parallel-groups, pragmatic, randomized, controlled single-blind study, which compared a 12-week POI (Deprexis) to care as usual (CAU). Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The main outcome of interest was change on self-rated depression severity (PHQ-9). RESULTS Compared to Millennials, Boomers used the intervention significantly more often (d = 0.45) and for a longer duration (d = 0.46), and endorsed more positive attitudes towards POIs (d = 0.14). There was no significant Age Group by Intervention Group interaction for change in PHQ-9. The post-assessment between-group effect size (intervention vs. CAU control) for Millennials and Boomers were d = 0.26 and d = 0.39, respectively, and were stable at follow-up (d = 0.37 and d = 0.39). LIMITATIONS Age-based dichotomization may not accurately represent participants' experiences with and use of technology. CONCLUSIONS The POI examined in this trial was superior to CAU and was comparably effective among groups of adults defined as Millennials and Baby Boomers. Adults of the Baby Boomer generation who participate in POIs may have more positive attitudes towards POIs compared to their younger counterparts.
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Affiliation(s)
- Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Fritz Hohagen
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Björn Meyer
- GAIA AG, Hamburg, Germany; Department of Psychology, City, University of London, London, UK
| | - Christina Späth
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany; Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
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C. Schneider B, Bücker L, Riker S, Karamatskos E, Jelinek L. A Pilot Study of Metacognitive Training (D-MCT) for Older Adults with Depression. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2018. [DOI: 10.1024/1016-264x/a000210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Depression remains one of the most common psychological disorders among older adults. Their response to antidepressants: however, is often unsatisfactory, and despite the proven efficacy of psychotherapies, a large treatment gap remains. Metacognitive Training for Depression (D-MCT) is a low-threshold group intervention. This article examines the feasibility, acceptance, and effects of D-MCT as an add-on intervention among a group of older adults (55+ years; N = 116). Participants completed measures of depression and dysfunctional attitudes, and provided subjective appraisals of the training. Per protocol analyses (n = 55) revealed a significant decrease in depressive symptoms (d = 1.06) and cognitive biases (d = 0.33). The findings demonstrate the feasibility and acceptance of D-MCT among older adults with depression.
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Affiliation(s)
- Brooke C. Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Riker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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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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21
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Burch S, Preston C, Bateup S. True technology-enabled mental health care: trust, agency and ageing. Mhealth 2018; 4:30. [PMID: 30221165 PMCID: PMC6131528 DOI: 10.21037/mhealth.2018.08.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/02/2018] [Indexed: 11/06/2022] Open
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22
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Haigh EAP, Bogucki OE, Sigmon ST, Blazer DG. Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions. Am J Geriatr Psychiatry 2018; 26:107-122. [PMID: 28735658 DOI: 10.1016/j.jagp.2017.06.011] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 12/16/2022]
Abstract
Is depression among older adults symptomatically different than younger adults? Is it more common or chronic or difficult to treat? Is depression in late life more likely to be attributed to psychological problems? Twenty-years ago, Dan Blazer, a pioneer known for his groundbreaking work on depression in older adulthood, conducted an important review of the existing literature to refute five commonly held beliefs about depression in late life. Now, two decades later, we call upon selected articles that are representative of our current knowledge to provide an update and identify research priorities. The research consensus spanning the past 20 years suggests that when compared with their younger counterparts, depression in older adults is not more common and is not more often caused by psychological factors. Although some studies have suggested that depression in late life may be symptomatically different and characterized by a more somatic presentation, there is insufficient empirical evidence to conclude that depression presents differently across adulthood. Overall, older adults respond to psychological interventions as well as younger adults, although evidence suggests that antidepressants are less efficacious in late life. Finally, compared with middle-aged adults, depression in older adults is associated with a more chronic course (i.e., higher rate of relapse), which is likely moderated by medical comorbidity. This special article summarizes our current understanding of the nature and treatment of late-life depression and highlights areas of inquiry in need of further study.
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Cuijpers P, Gentili C. Psychological treatments are as effective as pharmacotherapies in the treatment of adult depression: a summary from Randomized Clinical Trials and neuroscience evidence. ACTA ACUST UNITED AC 2017; 20:273. [PMID: 32913741 PMCID: PMC7451304 DOI: 10.4081/ripppo.2017.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Italy
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Leyhe T, Reynolds CF, Melcher T, Linnemann C, Klöppel S, Blennow K, Zetterberg H, Dubois B, Lista S, Hampel H. A common challenge in older adults: Classification, overlap, and therapy of depression and dementia. Alzheimers Dement 2016; 13:59-71. [PMID: 27693188 DOI: 10.1016/j.jalz.2016.08.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/21/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas Leyhe
- Center of Old Age Psychiatry Psychiatric University Hospital Basel Switzerland
| | - Charles F. Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh PA USA
| | - Tobias Melcher
- Center of Old Age Psychiatry Psychiatric University Hospital Basel Switzerland
| | - Christoph Linnemann
- Center of Old Age Psychiatry Psychiatric University Hospital Basel Switzerland
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy, Center for Geriatric Medicine and Gerontology, Department of Neurology University Medical Center Freiburg Freiburg Germany
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- University College London Institute of Neurology London UK
| | - Bruno Dubois
- Sorbonne Universités, Université Pierre et Marie Curie, Paris 06 Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) & Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié‐Salpêtrière Paris France
| | - Simone Lista
- IHU‐A‐ICM—Paris Institute of Translational Neurosciences Pitié‐Salpêtrière University Hospital Paris France
- AXA Research Fund & UPMC Chair Paris France
| | - Harald Hampel
- Sorbonne Universités, Université Pierre et Marie Curie, Paris 06 Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) & Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié‐Salpêtrière Paris France
- AXA Research Fund & UPMC Chair Paris France
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25
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Notzon S, Alferink J, Arolt V. [Late-onset depression : Pathophysiology, diagnostics and treatment]. DER NERVENARZT 2016; 87:1017-29. [PMID: 27531211 DOI: 10.1007/s00115-016-0193-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Late-onset depression (LOD) is defined as depression manifesting for the first time in later life. Up to now, there has been no exact definition of the lower age limit for LOD. Psychopathological symptoms of LOD do not fundamentally differ from depression in other phases of life; however, cognitive deficits are typically more pronounced. The LOD is associated with an increased risk of developing dementia. Imaging studies show reduction in gray matter volume and white matter lesions caused by vascular diseases. The occurrence of depression with vascular lesions of the brain is also referred to as "vascular depression". The diagnostic procedure includes a detailed medical history and the observation of psychopathological changes, physical examination, laboratory tests, electroencephalograph (EEG), electrocardiograph (ECG) and magnetic resonance imaging (MRI) of the head and neuropsychological tests to measure cognitive deficits. Psychotherapy is an effective treatment option. Selective serotonin reuptake inhibitors are the first-line pharmacological therapy.
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Affiliation(s)
- S Notzon
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A9, 48149, Münster, Deutschland.
| | - J Alferink
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A9, 48149, Münster, Deutschland
| | - V Arolt
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A9, 48149, Münster, Deutschland
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Driessen E, Hollon SD, Bockting CLH, Cuijpers P, Turner EH. Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded Trials. PLoS One 2015; 10:e0137864. [PMID: 26422604 PMCID: PMC4589340 DOI: 10.1371/journal.pone.0137864] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/22/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The efficacy of antidepressant medication has been shown empirically to be overestimated due to publication bias, but this has only been inferred statistically with regard to psychological treatment for depression. We assessed directly the extent of study publication bias in trials examining the efficacy of psychological treatment for depression. METHODS AND FINDINGS We identified US National Institutes of Health grants awarded to fund randomized clinical trials comparing psychological treatment to control conditions or other treatments in patients diagnosed with major depressive disorder for the period 1972-2008, and we determined whether those grants led to publications. For studies that were not published, data were requested from investigators and included in the meta-analyses. Thirteen (23.6%) of the 55 funded grants that began trials did not result in publications, and two others never started. Among comparisons to control conditions, adding unpublished studies (Hedges' g = 0.20; CI95% -0.11~0.51; k = 6) to published studies (g = 0.52; 0.37~0.68; k = 20) reduced the psychotherapy effect size point estimate (g = 0.39; 0.08~0.70) by 25%. Moreover, these findings may overestimate the "true" effect of psychological treatment for depression as outcome reporting bias could not be examined quantitatively. CONCLUSION The efficacy of psychological interventions for depression has been overestimated in the published literature, just as it has been for pharmacotherapy. Both are efficacious but not to the extent that the published literature would suggest. Funding agencies and journals should archive both original protocols and raw data from treatment trials to allow the detection and correction of outcome reporting bias. Clinicians, guidelines developers, and decision makers should be aware that the published literature overestimates the effects of the predominant treatments for depression.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Claudi L. H. Bockting
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Erick H. Turner
- Behavioral Health and Neurosciences Division, VA Portland Health Care System, Portland, Oregon, United States of America
- Departments of Psychiatry and Pharmacology, Oregon Health & Science University, Portland, Oregon, United States of America
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Anderson D. Depression: to screen or not to screen? Age Ageing 2015; 44:728-9. [PMID: 26259949 DOI: 10.1093/ageing/afv097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laidlaw K, Kishita N. Age-Appropriate Augmented Cognitive Behavior Therapy to Enhance Treatment Outcome for Late-Life Depression and Anxiety Disorders. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2015. [DOI: 10.1024/1662-9647/a000128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present an explanation of the benefits of using gerontological theory to augment treatment outcome in cognitive behavior therapy (CBT). Traditional formulations/conceptualizations of CBT may not always be the most optimal fit when working with older people, who may be experiencing different developmental life stages compared to adults of working age. In addressing how CBT may be different with older people, it is proposed that one may augment CBT outcome by applying gerontological theory as “vehicles for change.” This evidence-based scientist approach is consistent with standard practice in CBT. This paper outlines some examples of how gerontological theory can be useful to bring about an enhanced treatment outcome.
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Affiliation(s)
- Ken Laidlaw
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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Comijs HC, Nieuwesteeg J, Kok R, van Marwijk HW, van der Mast RC, Naarding P, Voshaar RCO, Verhaak P, de Waal MWM, Stek ML. The two-year course of late-life depression; results from the Netherlands study of depression in older persons. BMC Psychiatry 2015; 15:20. [PMID: 25775143 PMCID: PMC4329675 DOI: 10.1186/s12888-015-0401-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to examine the course of depression during 2-year follow-up in a group clinically depressed older persons. Subsequently, we studied which socio-demographic and clinical characteristics predict a depression diagnoses at 2-year follow-up. METHODS Data were used from the Netherlands Study of Depression in Older persons (NESDO; N = 510). Diagnoses of depression DSM-IV-TR criteria were available from 285 patients at baseline and at 2-year follow-up. Severity of the depressive symptoms, as assessed with the Inventory of Depressive Symptoms (IDS), was obtained from 6-monthly postal questionnaires. Information about socio-demographic and clinical variables was obtained from the baseline measurement. RESULT From the 285 older persons who were clinically depressed at baseline almost half (48.4%) also suffered from a depressive disorder two years later. Patients with more severe depressive symptoms, comorbid dysthymia, younger age of onset and more chronic diseases were more likely to be depressed at 2-year follow-up. 61% of the persons that were depressed at baseline had a chronic course of depressive symptoms during these two years. CONCLUSIONS Late-life depression often has a chronic course, even when treated conform current guidelines for older persons. Our results suggest that physical comorbidity may be candidate for adjusted and intensified treatment strategies of older depressed patients with chronic and complex pathology.
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Affiliation(s)
- Hannie C Comijs
- Department Psychiatry/EMGO Institute for Health and Care Research VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands ,GGZinGeest, Amsterdam, The Netherlands
| | | | - Rob Kok
- Parnassia/BAVO groep, Department of Old-age Psychiatry, The Hague, The Netherlands
| | - Harm W van Marwijk
- VU University Medical Center, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Naarding
- GGNet, Department of Old-age Psychiatry, Apeldoorn/Zutphen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands ,University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands
| | - Peter Verhaak
- Department General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands ,NIVEL, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
| | - Margot WM de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Knight BG, Durbin K. Aging and the effects of emotion on cognition: Implications for psychological interventions for depression and anxiety. Psych J 2015; 4:11-9. [PMID: 26263526 DOI: 10.1002/pchj.84] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/03/2014] [Indexed: 11/12/2022]
Abstract
We review findings from laboratory research on age differences in the effects of emotion on cognition. Particular attention is given to sadness leading to mood congruent memory and to anxiety leading to selective attention bias to threat. While older adults in normal moods show the positivity effect as expected from socio-emotional selectivity theory, older adults whose mood has changed from baseline to sad or anxious show these mood-related cognitive biases. These mood-related biases are a foundational part of the theory underlying cognitive behavior therapy (CBT) and so these laboratory findings suggest ways that CBT may work differently with older adults. Pilot work suggests that the presence or absence of these effects may also predict responsiveness to treatment using CBT.
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Affiliation(s)
- Bob G Knight
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kelly Durbin
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Abstract
PURPOSE OF REVIEW Much has been learned from the 400 randomized trials on psychotherapies for adult depression that have been conducted, but much is also still unknown. In this study some recent attempts to further reduce the disease burden of depression through psychotherapies are reviewed. RECENT FINDINGS In the past, many new psychotherapies have promised to be more effective than existing treatments, usually without success. We describe recent research on two new therapies, acceptance and commitment therapy and cognitive bias modification, and conclude that both have also not shown to be more effective than existing therapies. A growing number of studies have also focused on therapies that may be successful in further reducing the disease burden, such as treatments for chronic depression and relapse prevention. Other studies are aimed at scaling up psychological services, such as the training of lay health counselors in low-income and middle-income countries, telephone-based, and internet-based therapies. SUMMARY Psychotherapies are essential tools in the treatment of adult depression. Randomized trials have shown that these treatments are effective, and by focusing on key issues, such as chronic depression, relapse, and scaling them up, psychotherapies contribute more and more to the reduction of the disease burden of depression.
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Linde K, Sigterman K, Kriston L, Rücker G, Jamil S, Meissner K, Schneider A. Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Ann Fam Med 2015; 13:56-68. [PMID: 25583894 PMCID: PMC4291267 DOI: 10.1370/afm.1719] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We performed a systematic review of the currently available evidence on whether psychological treatments are effective for treating depressed primary care patients in comparison with usual care or placebo, taking the type of therapy and its delivery mode into account. METHODS Randomized controlled trials comparing a psychological treatment with a usual care or a placebo control in adult, depressed, primary care patients were identified by searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO up to December 2013. At least 2 reviewers extracted information from included studies and assessed the risk of bias. Random effects meta-analyses were performed using posttreatment depression scores as outcome. RESULTS A total of 30 studies with 5,159 patients met the inclusion criteria. Compared with control, the effect (standardized mean difference) at completion of treatment was -0.30 (95% CI, -0.48 to -0.13) for face-to-face cognitive behavioral therapy (CBT), -0.14 (-0.40 to 0.12) for face-to-face problem-solving therapy, -0.24 (-0.47 to -0.02) for face-to-face interpersonal psychotherapy, -0.28 (-0.44 to -0.12) for other face-to-face psychological interventions, -0.43 (-0.62 to -0.24) for remote therapist-led CBT, -0.56 (-1.57 to 0.45) for remote therapist-led problem-solving therapy, -0.40 (-0.69 to -0.11) for guided self-help CBT, and -0.27 (-0.44 to -0.10) for no or minimal contact CBT. CONCLUSIONS There is evidence that psychological treatments are effective in depressed primary care patients. For CBT approaches, substantial evidence suggests that interventions that are less resource intensive might have effects similar to more intense treatments.
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Affiliation(s)
- Klaus Linde
- Institute of General Practice, Technische Universität München, Munich, Germany
| | - Kirsten Sigterman
- Institute of General Practice, Technische Universität München, Munich, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, University Medical Center Freiburg, Freiburg, Germany
| | - Susanne Jamil
- Institute of General Practice, Technische Universität München, Munich, Germany
| | - Karin Meissner
- Institute of General Practice, Technische Universität München, Munich, Germany Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice, Technische Universität München, Munich, Germany
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Gum AM, Hirsch A, Dautovich ND, Ferrante S, Schonfeld L. Six-month utilization of psychotherapy by older adults with depressive symptoms. Community Ment Health J 2014; 50:759-64. [PMID: 24481984 PMCID: PMC4197899 DOI: 10.1007/s10597-014-9704-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
We explored psychotherapy utilization patterns for community-dwelling older adults with depressive symptoms identified during a statewide initiative designed for identifying risk of substance misuse. Individuals screening negative for substance misuse, but positive for depressive symptoms, agreed to participate in monthly interviews conducted over 6 months (n = 144). Results showed that 39 (27%) received psychotherapy, of which nearly two-thirds reported four or fewer visits. Mental health counselors were the most frequently reported service providers (50-62.5%). Location of service varied considerably. This study documents low rates of psychotherapy use and few visits. Current efforts to increase psychotherapy access are discussed.
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Affiliation(s)
- Amber M Gum
- Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Blvd., MHC 2632A, Tampa, FL, 33612, USA,
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Enduring effects of evidence-based psychotherapies in acute depression and anxiety disorders versus treatment as usual at follow-up — A longitudinal meta-analysis. Clin Psychol Rev 2014; 34:367-75. [DOI: 10.1016/j.cpr.2014.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/05/2014] [Accepted: 05/08/2014] [Indexed: 11/19/2022]
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Prina AM, Marioni RE, Hammond GC, Jones PB, Brayne C, Dening T. Improving access to psychological therapies and older people: findings from the Eastern Region. Behav Res Ther 2014; 56:75-81. [PMID: 24727362 PMCID: PMC4007011 DOI: 10.1016/j.brat.2014.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 03/14/2014] [Accepted: 03/19/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Evaluations of the Improving Access to Psychological Therapies (IAPT) scheme have not yet focused on minority subgroups. This paper aims to evaluate accessibility, waiting times and clinical outcomes of IAPT for older adults. METHODS All referrals from six Primary Care Trusts (PCT) in the East of England were used in this analysis. During each session, the therapist recorded information on anxiety symptoms using the Generalised Anxiety Disorder Questionnaire (GAD-7) and depressive symptoms with the Patient Health Questionnaire (PHQ-9). Waiting times, type of referrals and reliable recovery rates were investigated. RESULTS Older adults accounted for only 4% of all the IAPT referrals made between September 2008 and July 2010 in the Eastern Region. Waiting times for both IAPT assessment and treatment were slightly lower for older adult. In all centres, reliable recovery rates were higher in older adults compared to younger adults post-treatment, however these differences were not significant, with the exception of a difference in anxiety scores (χ(2)(1) = 18.6, p < 0.001). In multivariate analyses, being an older adult was associated with recovery for depression (OR = 1.30, 95% CI 1.10-1.53), anxiety (OR = 1.42, 95% CI 1.21-1.66), and overall recovery (OR = 1.31, 95% CI 1.10-1.54) after adjustment for gender, PCT region, baseline score, maximum treatment step during treatment, dropping out, and number of sessions. CONCLUSIONS The IAPT services were shown to be beneficial to older patients, however, access to these services in later life has been lower than expected. The service pathway for older populations needs to be better researched in order to eliminate possible obstacles in accessing services.
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Affiliation(s)
- A Matthew Prina
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, University Forvie Site, Cambridge CB2 0SR, UK; NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; King's College London, Institute of Psychiatry, Health Service and Population Research Department, Centre for Global Mental Health, London SE5 8AF, UK.
| | - Riccardo E Marioni
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, University Forvie Site, Cambridge CB2 0SR, UK
| | - Geoffrey C Hammond
- NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; Department of Psychiatry, University of Cambridge, UK
| | - Peter B Jones
- NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; Department of Psychiatry, University of Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, University Forvie Site, Cambridge CB2 0SR, UK; NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK
| | - Tom Dening
- NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; Division of Psychiatry, Institute of Mental Health, University of Nottingham, UK
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Abstract
It has become increasingly apparent that older adults may not only benefit from psychoanalysis and psychodynamic psychotherapy but may be particularly well suited to such treatment. Clinical evidence to support this is presented, including discussion of the successful psychoanalysis of a woman in her seventies. An overview of the psychoanalytic literature indicates that psychoanalytic beliefs about the feasibility of treating older patients have always been favorable, but have had difficulty gaining traction. The modern psychoanalytic literature is compatible with extra-analytic studies of aging that provide further rationale for the potential usefulness of psychoanalytically oriented interventions in the elderly population.
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Affiliation(s)
- Daniel A Plotkin
- Clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine, University of California at Los Angeles
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van Schaik DJF, Dozeman E, van Marwijk HWJ, Stek ML, Smit F, Beekman ATF, van der Horst HE. Preventing depression in homes for older adults: are effects sustained over 2 years? Int J Geriatr Psychiatry 2014; 29:191-7. [PMID: 23737075 DOI: 10.1002/gps.3989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 05/02/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the 2-year effects of a stepped-care programme to prevent the onset of a major depressive disorder (MDD) in older people living in residential homes. METHODS A 2-year follow-up study of a pragmatic randomised controlled trial was conducted in 14 residential homes in the Netherlands. A total of 185 residents (Center for Epidemiologic Studies Depression Scale score >7), who did not meet the diagnostic criteria for MDD, were randomised to a stepped-care programme (n = 93) or to usual care (n = 92). Stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review and a consultation with the general practitioner. The primary outcome measure was the incidence of MDD during a period of 2 years, according to the Mini International Neuropsychiatric Interview. RESULTS After 2 years, the incidence of MDD was not significantly reduced in the intervention group compared with the control group (incidence rate ratio: 0.98; 95% confidence interval (CI) [0.54, 1.81]). However, in the completer analysis, on the basis of 79 residents who completed the 2-year measurements, there was a significant difference in favour of the intervention group (incidence rate ratio: 0.53; 95% CI [0.32, 0.87]). Dropout percentages were high (44%), mostly accounted for by illness and death (68%). CONCLUSION A minority of residents had benefit from the intervention that sustained after 2 years in the completer group. Yet, these findings cannot be generalised as the majority of the residents did not opt for participation in the project and many dropped out. Ways should be sought to motivate residents with depressive symptoms to engage in preventive interventions.
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Affiliation(s)
- Digna J F van Schaik
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
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McMurchie W, Macleod F, Power K, Laidlaw K, Prentice N. Computerised cognitive behavioural therapy for depression and anxiety with older people: a pilot study to examine patient acceptability and treatment outcome. Int J Geriatr Psychiatry 2013; 28:1147-56. [PMID: 23495124 DOI: 10.1002/gps.3935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 01/04/2013] [Accepted: 01/22/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study objective was to determine the acceptability and treatment outcome of using Beating the Blues (BTB) with older people (6 + years). Specific aims included identifying the treatment uptake and drop-out rate, and describing the role of basic demographics in therapy uptake. METHOD Fifty-eight participants, experiencing symptoms of depression, were given a free choice of receiving treatment as usual (TAU) plus BTB (TAU + BTB) or TAU alone. All participants completed demographic questionnaires and a range of outcome measures at baseline, 2 months after baseline (end of treatment) and 3 months after baseline (follow-up). RESULTS Thirty-three participants (56.9%) opted to receive BTB and reported having more experience and confidence using a computer than those who declined BTB. Twenty-four participants (72.7%) went on to complete all eight BTB sessions. Statistical analysis found significant differences between the two treatment groups, with the TAU + BTB group showing greater improvements in their symptoms of depression and anxiety than the TAU group by the end of treatment and at follow-up. Furthermore, the TAU+ BTB group had a significantly higher percentage of participants who met criteria for clinically significant improvement in their symptoms of depression by the end of treatment and at follow-up. CONCLUSION Although further research is required, including a randomised controlled trial, the results of this initial pilot study provide evidence that BTB may offer an acceptable and effective treatment option for older people.
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Affiliation(s)
- William McMurchie
- NHS Tayside, Clinical Psychology to General Adult Psychiatry, The Alloway Centre, Dundee, UK
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Cuijpers P, Berking M, Andersson G, Quigley L, Kleiboer A, Dobson KS. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:376-85. [PMID: 23870719 DOI: 10.1177/070674371305800702] [Citation(s) in RCA: 590] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis. METHODS Studies were identified through systematic searches in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy. RESULTS A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower (g = 0.53) than for lower-quality studies (g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone (g = 0.49). CONCLUSIONS There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, the Netherlands.
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Laidlaw K. A Deficit in Psychotherapeutic Care for Older People with Depression and Anxiety. Gerontology 2013; 59:549-56. [DOI: 10.1159/000351439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 04/17/2013] [Indexed: 11/19/2022] Open
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Zou JB, Dear BF, Titov N, Lorian CN, Johnston L, Spence J, Knight RG, Anderson T, Sachdev P. Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: a feasibility trial. J Anxiety Disord 2012; 26:650-5. [PMID: 22659078 DOI: 10.1016/j.janxdis.2012.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 04/17/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
This study examined the efficacy of an Internet-delivered cognitive-behavior therapy program developed for older adults. Twenty-two participants with elevated scores (≥8) on the Generalized Anxiety Disorder 7-Item Scale (GAD-7) participated in the course, which consisted of five lessons, homework tasks, additional resources, a moderated discussion forum, and weekly telephone support from a Clinical Psychologist. Ninety-five percent of the sample met diagnostic criteria for an anxiety disorder at pre-treatment. All participants completed the five lessons within the allotted eight weeks. Three-month follow-up data was collected from 95% of participants. Reductions in symptoms of anxiety and stress, with large within-group effect sizes (Cohen's d) were found on the GAD-7 (d=1.03) and the Depression, Anxiety and Stress Scales - 21 Items (d=0.98) at follow-up. Participants reported high levels of satisfaction with the program. These encouraging results provide tentative support for the online treatment of older adults with anxiety.
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Affiliation(s)
- Judy B Zou
- The Centre for Emotional Health, Department of Psychology, Macquarie University, NSW 2109, Australia.
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Contradictory effects for prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial. Int Psychogeriatr 2012; 24:1242-51. [PMID: 22436082 DOI: 10.1017/s1041610212000178] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness of a stepped-care program to prevent the onset of depression and anxiety disorders in elderly people living in residential homes. METHODS A pragmatic randomized controlled trial was conducted to compare the intervention with usual care in 14 residential homes in the Netherlands. A total of 185 residents with a minimum score of 8 on the Centre for Epidemiologic Studies Depression Scale, who did not meet the diagnostic criteria for a depressive or anxiety disorder, and were not suffering from severe cognitive impairment, were recruited between April 2007 and December 2008. They were randomized to a stepped-care program (N = 93) or to usual care (N = 92). The stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review, and a consultation with the general practitioner. The primary outcome measure was the incidence of a major depressive disorder (MDD) or anxiety disorder during a period of one year according to the Mini International Neuropsychiatric Interview. RESULTS The intervention was not effective in reducing the incidence of the combined outcome of depression and anxiety (incidence rate ratio (IRR) = 0.50; 95% confidence interval (CI) = 0.23-1.12). However, the intervention was superior to usual care in reducing the risk of MDD incidence (IRR = 0.26; 95% CI = 0.12-0.80) contrary to anxiety incidence (IRR = 1.32; 95% CI = 0.48-3.62). CONCLUSIONS These results suggest that the stepped-care program is effective in reducing the incidence of depression, but is not effective in preventing the onset of anxiety disorders in elderly people living in residential homes.
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Cuijpers P, Andersson G, Donker T, van Straten A. Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry 2011; 65:354-64. [PMID: 21770842 DOI: 10.3109/08039488.2011.596570] [Citation(s) in RCA: 193] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In the past few decades, a considerable number of studies have examined the effects of psychotherapies for adult depression. AIM We described the results of a series of meta-analyses examining what this large body of research has contributed to our knowledge of these treatments of depression. RESULTS We found that different types of psychotherapy are efficacious in the treatment of adult depression, including cognitive behavior therapy, interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy. Differences between types of psychotherapy are small. The efficacy of psychotherapy for mild to moderate depression is about the same as the efficacy of pharmacotherapy, and that combined treatment is more effective than psychotherapy alone and pharmacotherapy alone. Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients, in primary care patients, patients with chronic depression and in subthreshold depression. CONCLUSIONS We found no evidence showing that psychotherapy is less efficacious in severe depression (with mean baseline Hamilton Depression Rating Scale scores up to 31, mean Beck Depression Inventory scores up to 35.85 and mean Beck Depression Inventory-II scores up to 36.50), but effects are smaller in chronic depression. We also found that the effects of psychotherapy are probably overestimated because of publication bias and the relatively low quality of many studies in the field.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, The Netherlands
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Clark S. Integration of supportive psychotherapy with case management for older adults with borderline personality disorder. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2011; 54:627-638. [PMID: 21780885 DOI: 10.1080/01634372.2011.585391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article attempts to demonstrate how supportive psychotherapy may serve as a companion therapeutic modality for case management activities with older adult clients suffering with borderline personality disorder (BPD). Justification for this approach is provided and techniques and interventions are identified. Three case examples demonstrating the modalities integration are provided.
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Affiliation(s)
- Steven Clark
- Department of Social Welfare, University of California-Los Angeles, Lusckin School of Public Affairs, Los Angeles, CA 90095-1656, USA.
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Incorporation of massage into psychotherapy: An integrative and conjoint approach. Chin J Integr Med 2011; 17:154-8. [DOI: 10.1007/s11655-011-0633-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Indexed: 11/27/2022]
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Thielke SM, Diehr P, Unützer J. Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study. Aging Ment Health 2010; 14:168-76. [PMID: 20336548 PMCID: PMC3622544 DOI: 10.1080/13607860903046537] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To explore the association of major depressive symptoms with advancing age, sex, and self-rated health among older adults. DESIGN AND METHODS We analyzed 10 years of annual assessments in a longitudinal cohort of 5888 Medicare recipients in the Cardiovascular Health Study. Self-rated health was assessed with a single question, and subjects categorized as healthy or sick. Major depressive symptoms were assessed using the Center for Epidemiologic Studies Short Depression Scale, with subjects categorized as nondepressed (score < 10) or depressed (> or =10). Age-, sex-, and health-specific prevalence of depression and the probabilities of transition between depressed and nondepressed states were estimated. RESULTS The prevalence of a major depressive state was higher in women, and increased with advancing age. The probability of becoming depressed increased with advancing age among the healthy but not the sick. Women showed a greater probability than men of becoming depressed, regardless of health status. Major depressive symptoms persisted over one-year intervals in about 60% of the healthy and 75% of the sick, with little difference between men and women. IMPLICATIONS Clinically significant depressive symptoms occur commonly in older adults, especially women, increase with advancing age, are associated with poor self-rated health, and are largely intransigent. In order to limit the deleterious consequences of depression among older adults, increased attention to prevention, screening, and treatment is warranted. A self-rated health item could be used in clinical settings to refine the prognosis of late-life depression.
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Affiliation(s)
- Stephen M. Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1660s Columbian way, S-182 GRECC, Seattle 98108, USA
,Corresponding author.
| | - Paula Diehr
- Department of Biostatistics, University of Washington, Seattle 98195, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1660s Columbian way, S-182 GRECC, Seattle 98108, USA
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