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Noreen S, Dritschel B. Thinking about the consequences: The detrimental role of future thinking on intrapersonal problem-solving in depression. PLoS One 2023; 18:e0289676. [PMID: 37611035 PMCID: PMC10446235 DOI: 10.1371/journal.pone.0289676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Despite the fact that depressed individuals encounter a multitude of social problems in daily life, research on social problem-solving has largely been dominated by research on interpersonal problems and there is a paucity of research on intrapersonal problems. Intrapersonal problems are linked to one's subjective psychological functioning and involve managing one's own feelings and emotions pertaining to the self. Given that depressed individuals exhibit impaired emotion regulation, it is possible that their ability to solve intrapersonal problems may be impaired, especially in relation to future thinking. The aim of this study was to investigate whether future thinking, in the form of thinking about the consequences of a problem being resolved or remaining unresolved has an impact on intrapersonal problem-solving in depression. Forty-five depressed and fifty-four non-depressed participants completed a modified version of the means end problem-solving task (MEPS). In the task, participants were presented with a series of intrapersonal problems and were asked to generate consequences of the problems being resolved or remaining unresolved. Participants were then presented with a positive resolution to each of the problems and were asked to solve the problem to achieve the positive resolution. Following a delay, participants were asked to recall all of the consequences initially generated. Overall, depressed individuals generated fewer-relevant means and less effective solutions to problems than non-depressed participants. Depressed individuals also demonstrated impaired intrapersonal problem-solving following the generation of resolved and unresolved consequences, compared to a baseline condition, where no consequences were generated. These findings suggest that future thinking impairs intrapersonal problem-solving and indicates that a more nuanced approach to future thinking and social problem-solving in depression is needed across different real-life problem-solving contexts.
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Affiliation(s)
- Saima Noreen
- Department of Psychology, De Montfort University, Leicester, England
| | - Barbara Dritschel
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, Scotland
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Wu Y, Zhang X, Yu T, Sui X, Li Y, Xu H, Zeng T, Leng X, Zhao L, Li F. Effects of reminiscence therapy combined with memory specificity training (RT-MeST) on depressive symptoms in older adults: a randomized controlled trial protocol. BMC Geriatr 2023; 23:398. [PMID: 37386362 PMCID: PMC10308705 DOI: 10.1186/s12877-023-03967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/12/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Geriatric depression has become a serious public health problem, and reduced autobiographical memory and increased overgeneral memory, as the main cognitive markers of depression, are not only associated with current depressive symptoms but also associated with the onset and course of depression, which can lead to a range of harms. Economic and effective psychological interventions are urgently needed. The aim of this study is to confirm the effectiveness of reminiscence therapy combined with memory specificity training in improving autobiographical memory and depressive symptoms in older adults. METHODS In this multicentre, single-blind, three-arm parallel randomized controlled study, we aim to enrol 78 older adults aged 65 years or older with a score of ≥ 11 on the Geriatric Depression Scale, and participants will be randomly assigned to either a reminiscence therapy group, a reminiscence therapy with memory specificity training group or a usual care group. Assessments will be conducted at baseline (T0) as well as immediately post-intervention (T1) and 1 (T2), 3 (T3) and 6 (T4) months post-intervention. The primary outcome measure is self-reported depressive symptoms, measured using the GDS. Secondary outcome measures include measures of autobiographical memory, rumination, and social engagement. DISCUSSION We believe that the intervention will play a positive role in improving autobiographical memory and depressive symptoms in older adults. Poor autobiographical memory is a predictor of depression and a major cognitive marker, and improving autobiographical memory is of great significance in alleviating depressive symptoms in older people. If our program is effective, it will provide a convenient and feasible strategy for further promoting healthy ageing. TRIAL REGISTRATION ChiCTR2200065446.
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Affiliation(s)
- Yuejin Wu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Xin Zhang
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Tianzhuo Yu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Xin Sui
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Yuewei Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Haiyan Xu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Ting Zeng
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Xin Leng
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Lijing Zhao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China.
| | - Feng Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China.
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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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4
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Cawley E, Piazza G, Das RK, Kamboj SK. A systematic review of the pharmacological modulation of autobiographical memory specificity. Front Psychol 2022; 13:1045217. [PMID: 36452391 PMCID: PMC9703074 DOI: 10.3389/fpsyg.2022.1045217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2022] [Indexed: 08/31/2023] Open
Abstract
Background Over-general autobiographical memory (AM) retrieval is proposed to have a causal role in the maintenance of psychological disorders like depression and PTSD. As such, the identification of drugs that modulate AM specificity may open up new avenues of research on pharmacological modeling and treatment of psychological disorders. Aim The current review summarizes randomized, placebo-controlled studies of acute pharmacological modulation of AM specificity. Method A systematic search was conducted of studies that examined the acute effects of pharmacological interventions on AM specificity in human volunteers (healthy and clinical participants) measured using the Autobiographical Memory Test. Results Seventeen studies were identified (986 total participants), of which 16 were judged to have low risk of bias. The presence and direction of effects varied across drugs and diagnostic status of participants (clinical vs. healthy volunteers). The most commonly studied drug-hydrocortisone-produced an overall impairment in AM specificity in healthy volunteers [g = -0.28, CI (-0.53, -0.03), p = 0.03], although improvements were reported in two studies of clinical participants. In general, studies of monoamine modulators reported no effect on specificity. Conclusion Pharmacological enhancement of AM specificity is inconsistent, although monaminergic modulators show little promise in this regard. Drugs that reduce AM specificity in healthy volunteers may be useful experimental-pharmacological tools that mimic an important transdiagnostic impairment in psychological disorders. Systematic review registration PROSPERO, identifier CRD42020199076, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020199076.
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Affiliation(s)
- Emma Cawley
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Tyler E, Lobban F, Sutton C, Hadarag B, Johnson S, Depp C, Duncan D, Jones SH. A pilot randomised controlled trial to assess the feasibility and acceptability of recovery-focused therapy for older adults with bipolar disorder. BJPsych Open 2022; 8:e191. [PMID: 36278451 PMCID: PMC9634560 DOI: 10.1192/bjo.2022.582] [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] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite increasing evidence for the effectiveness of individual psychological interventions for bipolar disorder, research on older adults is lacking. We report the first randomised controlled trial of psychological therapy designed specifically for older adults with bipolar disorder. AIMS To evaluate the feasibility and acceptability of recovery-focused therapy, designed in collaboration with older people living with bipolar disorder. METHOD A parallel, two-armed, randomised controlled trial comparing treatment as usual with up to 14 sessions of recovery-focused therapy plus treatment as usual, for older adults with bipolar disorder. RESULTS Thirty-nine participants (67% female, mean age 67 years) were recruited over a 17-month period. Feasibility and acceptability of recruitment, retention (>80% observer-rated outcomes at both 24 and 48 weeks) and intervention processes were demonstrated. The majority of participants started therapy when offered, adhered to the intervention (68% attended all sessions and 89% attended six or more sessions) and reported positive benefits. Clinical assessment measures provide evidence of a signal for effectiveness on a range of outcomes including mood symptoms, time to relapse and functioning. No trial-related serious adverse events were identified. CONCLUSIONS Recovery-focused therapy is feasible, acceptable and has the potential to improve a range of outcomes for people living with bipolar disorder in later life. A large-scale trial is warranted to provide a reliable estimate of its clinical and cost-effectiveness.
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Affiliation(s)
- Elizabeth Tyler
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
| | - Christopher Sutton
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK
| | | | - Sheri Johnson
- Department of Psychology, University of California, Berkeley, USA
| | - Colin Depp
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, USA
| | | | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
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Hollister B, Crabb R, Kaplan S, Brandner M, Areán P. Effectiveness of Case Management with Problem-Solving Therapy for Rural Older Adults with Depression. Am J Geriatr Psychiatry 2022; 30:1083-1092. [PMID: 35379537 DOI: 10.1016/j.jagp.2022.03.001] [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: 11/29/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the effect of case management with problem solving therapy (CM-PST) on depression and disability among rural older adults and compare its effect with outcomes derived from a previous, but similar study among 84 urban older adults. METHODS This study examined the comparative effectiveness of a CM-PST intervention for older adults with depression and unmet needs across rural and urban settings. Participants received 12 one-hour sessions of CM-PST with a master's-level clinician. A total of 56 rural and 84 urban adults aged 60 and older experiencing mild to moderate depression received services in their homes. RESULTS The rural CM-PST intervention resulted in significantly reduced depression (reduction of 13.9 points, 95% CI 12.2 to 15.7, t(422)= 15.35, p<0.0001) and disability by week 12 (reduction of 6.7 points, 95% CI 4.8 to 8.5, t(425)= 7.01, p<0.0001). Reductions in depression and disability were sustained through week 24. The reductions in depression (F=3.98 df=4,388. p=0.0035) and disability (F=2.71, df=4,381, p=0.03) found in the rural sample were comparable to, or better than, those found in the urban sample. Improvements in unmet need and resilience predicted lower depression scores at 12 weeks, while improvements in unmet need and hopelessness predicted improvements in disability. No moderators of depression were identified, but baseline values of self-efficacy, resilience, and hopelessness moderated disability. CONCLUSIONS CM-PST was as effective at reducing depression and disability among rural older adults as it was for urban older adults. Home-delivered CM-PST can be successfully adapted to meet the specific needs of rural seniors using resources often available in rural communities.
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Affiliation(s)
- Brooke Hollister
- University of California, San Francisco (BH, RC, SK, MB); Center for Caring Research, University of Agder, Norway (BH).
| | - Rebecca Crabb
- University of California, San Francisco (BH, RC, SK, MB)
| | - Sandi Kaplan
- University of California, San Francisco (BH, RC, SK, MB)
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Razavi SZ, Schubert LK, van Orden K, Ali MR, Kane B, Hoque E. Discourse Behavior of Older Adults Interacting With a Dialogue Agent Competent in Multiple Topics. ACM T INTERACT INTEL 2022. [DOI: 10.1145/3484510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
We present a conversational agent designed to provide realistic conversational practice to older adults at risk of isolation or social anxiety, and show the results of a content analysis on a corpus of data collected from experiments with elderly patients interacting with our system. The conversational agent, represented by a virtual avatar, is designed to hold multiple sessions of casual conversation with older adults. Throughout each interaction, the system analyzes the prosodic and nonverbal behavior of users and provides feedback to the user in the form of periodic comments and suggestions on how to improve. Our avatar is unique in its ability to hold natural dialogues on a wide range of everyday topics – 27 topics in three groups, developed in collaboration with a team of gerontologists. The three groups vary in “degrees of intimacy”, and as such in degrees of cognitive difficulty for the user. After collecting data from 9 participants who interacted with the avatar for 7-9 sessions over a period of 3-4 weeks, we present results concerning dialogue behavior and inferred sentiment of the users. Analysis of the dialogues reveals correlations such as greater elaborateness for more difficult topics, increasing elaborateness with successive sessions, stronger sentiments in topics concerned with life goals rather than routine activities, and stronger self-disclosure for more intimate topics. In addition to their intrinsic interest, these results also reflect positively on the sophistication and practical applicability of our dialogue system.
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Alexopoulos GS, Raue PJ, Banerjee S, Marino P, Renn BN, Solomonov N, Adeagbo A, Sirey JA, Hull TD, Kiosses DN, Mauer E, Areán PA. Comparing the streamlined psychotherapy "Engage" with problem-solving therapy in late-life major depression. A randomized clinical trial. Mol Psychiatry 2021; 26:5180-5189. [PMID: 32612251 PMCID: PMC7775269 DOI: 10.1038/s41380-020-0832-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
Effective psychotherapies for late-life depression are underutilized, mainly because of their complexity. "Engage" is a novel, streamlined psychotherapy that relies on neurobiology to identify core behavioral pathology of late-life depression and targets it with simple interventions, co-designed with community therapists so that they can be delivered in community settings. Consecutively recruited adults (≥60 years) with major depression (n = 249) were randomly assigned to 9 weekly sessions of "Engage" or to the evidence-based Problem-Solving Therapy (PST) offered by 35 trained community social workers and assessed by blind raters. "Engage" therapists required an average of 30% less training time to achieve fidelity to treatment than PST therapists and had one-third of the PST therapists' skill drift. Both treatments led to reduction of HAM-D scores over 9 weeks. The mixed effects model-estimated HAM-D ratings were not significantly different between the two treatments at any assessment point of the trial. The one-sided 95% CI for treatment-end difference was (-∞, 0.07) HAM-D points, indicating a non-inferiority margin of 1.3 HAM-D points or greater; this margin is lower than the pre-determined 2.2-point margin. The two treatment arms had similar response (HR = 1.08, 95% CI (0.76, 1.52), p = 0.67) and remission rates (HR = 0.89, 95% CI (0.57, 1.39), p = 0.61). We conclude that "Engage" is non-inferior to PST. If disseminated, "Engage" will increase the number of therapists who can reliably treat late-life depression and make effective psychotherapy available to large numbers of depressed older adults.
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Affiliation(s)
- George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA.
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Samprit Banerjee
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY
| | - Patricia Marino
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY
| | - Brenna N. Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY
| | - Adenike Adeagbo
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY
| | - Jo Anne Sirey
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY
| | - Thomas D. Hull
- Talkspace, New York, NY,Teachers College, Columbia University, New York, NY
| | - Dimitris N. Kiosses
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY
| | - Elizabeth Mauer
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Gramaglia C, Gattoni E, Marangon D, Concina D, Grossini E, Rinaldi C, Panella M, Zeppegno P. Non-pharmacological Approaches to Depressed Elderly With No or Mild Cognitive Impairment in Long-Term Care Facilities. A Systematic Review of the Literature. Front Public Health 2021; 9:685860. [PMID: 34336772 PMCID: PMC8322575 DOI: 10.3389/fpubh.2021.685860] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Compared to old people who live at home, depressive symptoms are more prevalent in those who live in long-term care facilities (LTCFs). Different kinds of non-pharmacological treatment approaches in LTCFs have been studied, including behavioral and cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and life review/reminiscence. The aim of the current review was to systematically review non-pharmacological treatments used to treat depressed older adults with no or mild cognitive impairment (as described by a Mini Mental State Examination score > 20) living in LTCFs. Methods: A research was performed on PubMed and Scopus databases. Following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flowchart, studies selection was made. The quality of each Randomized Controlled Trial was scored using the Jadad scale, Quasi-Experimental Design studies and Non-Experimental studies were scored based on the Newcastle-Ottawa Scale (NOS) Results: The review included 56 full text articles; according to the type of intervention, studies were grouped in the following areas: horticulture/gardening (n = 3), pet therapy (n = 4), physical exercise (n = 9), psychoeducation/rehabilitation (n = 15), psychotherapy (n = 3), reminiscence and story sharing (n = 14), miscellaneous (n = 8). Discussion and Conclusion: Despite mixed or negative findings in some cases, most studies included in this systematic review reported that the non-pharmacological interventions assessed were effective in the management of depressed elderly in the LTCFs context. Regrettably, the limitations and heterogeneity of the studies described above hinder the possibility to generalize and replicate results.
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Affiliation(s)
- Carla Gramaglia
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Eleonora Gattoni
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Debora Marangon
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Diego Concina
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Elena Grossini
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Carmela Rinaldi
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Massimiliano Panella
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
- Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
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10
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Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials. Aging Clin Exp Res 2021; 33:1465-1475. [PMID: 32767273 DOI: 10.1007/s40520-020-01672-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Major depressive disorder is a global public health problem among older adults. Many studies show that problem-solving therapy (PST) is a cognitive behavioral approach that can effectively treat late-life depression. AIM To summarize and assess the effects of PST on major depressive disorders in older adults. METHODS We searched the PubMed, Web of Science, Cochrane Library, EMBASE, MEDLINE, UpToDate, and PsycINFO databases and three Chinese databases (CNKI, CBM, and Wan Fang Data) to identify articles written in English or Chinese that were published until Feb 1, 2020. Randomized controlled trials were included if they evaluated the impact of PST on major depression disorder (MDD) in older adults. Two authors of this review independently selected the studies, assessed the risk of bias, and extracted the data from all the included studies. We calculated the standard mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We assessed heterogeneity using the I2 statistic. RESULTS Ten studies with a total of 892 participants met the inclusion criteria. Subgroup analyses and quality ratings were performed. After problem-solving therapy, the depression scores in the intervention group were significantly lower than those in the control group (SMD = - 1.06, 95% CI - 1.52 to - 0.61, p < 0.05; I2 = 88.4%). DISCUSSION Compared with waitlist (WL), PST has a significant effect on elderly patients with depression, but we cannot rank the therapeutic effects of all the treatment methods used for MDD. CONCLUSIONS Our meta-analysis and systematic review suggest that problem-solving therapy may be an effective approach to improve major depressive disorders in older adults.
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Affiliation(s)
- Pingping Shang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Xuelian Cao
- School of Nursing, Jilin University, No. 965 XinJiang Road, Changchun, 130021, Jilin, China
| | - Simiao You
- Department of Nursing Welfare, College of Humanities and Sciences of Northeast, College of Health and Welfare, Normal University, Changchun, 130117, China
| | - Xuezhu Feng
- School of Nursing, Jilin University, No. 965 XinJiang Road, Changchun, 130021, Jilin, China
| | - Na Li
- Laboratory of Molecular Pharmacology, Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, 130117, Jilin, China.
| | - Yong Jia
- School of Nursing, Jilin University, No. 965 XinJiang Road, Changchun, 130021, Jilin, China.
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11
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Chen YJ, Li XX, Pan B, Wang B, Jing GZ, Liu QQ, Li YF, Bing ZT, Yang KH, Han XM, Ge L. Non-pharmacological interventions for older adults with depressive symptoms: a network meta-analysis of 35 randomized controlled trials. Aging Ment Health 2021; 25:773-786. [PMID: 31880174 DOI: 10.1080/13607863.2019.1704219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms.Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software.Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99-3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90-2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84-4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71-3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23-2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects.Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings.
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Affiliation(s)
- Ya-Jing Chen
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Xiu-Xia Li
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Bei Pan
- Gansu Provincial Hospital, Lanzhou, China
| | - Bangwei- Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Guang-Zhuang Jing
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qian-Qian Liu
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yan-Fei Li
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Zhi-Tong Bing
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Ke-Hu Yang
- Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xue-Mei Han
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Long Ge
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
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12
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Hoertel N, Rotenberg L, Schuster JP, Blanco C, Lavaud P, Hanon C, Hozer F, Teruel E, Manetti A, Costemale-Lacoste JF, Seigneurie AS, Limosin F. Generalizability of pharmacologic and psychotherapy trial results for late-life unipolar depression. Aging Ment Health 2021; 25:367-377. [PMID: 31726850 DOI: 10.1080/13607863.2019.1691146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Despite evidence of low representativeness of clinical trial results for depression in adults, the generalizability of clinical trial results for late-life depression is unknown. This study sought to quantify the representativeness of pharmacologic and psychotherapy clinical trial results for late-life unipolar depression. METHOD Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 adults from the United States population. To assess the generalizability of clinical trial results for late-life depression, we applied a standard set of eligibility criteria representative of pharmacologic and psychotherapy clinical trials to all individuals aged 65 years and older in NESARC with a DSM-IV diagnosis of MDE and no lifetime history of mania/hypomania (n = 273) and in a subsample of individuals seeking help for depression (n = 78). RESULTS More than four of ten respondents and about two of ten respondents would have been excluded by at least one exclusion criterion in a typical pharmacologic and psychotherapy efficacy trial, respectively. Similar results (i.e.41.1% and 25.9%, respectively) were found in the subsample of individuals seeking help for depression. Excess percentage of exclusion in typical pharmacologic studies was accounted for by the criterion "significant medical condition". We also found that populations typically included in pharmacologic and psychotherapy clinical trials for late-life unipolar depression may substantially differ. CONCLUSION Psychotherapy trial results may be representative of most patients with late-life unipolar depression in routine clinical practice. By contrast, pharmacologic clinical trials may not be readily generalizable to community samples.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Léa Rotenberg
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Jean-Pierre Schuster
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Pierre Lavaud
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Franz Hozer
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Elisabeth Teruel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Aude Manetti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | | | - Anne-Sophie Seigneurie
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Corentin-Celton, Service de Psychiatrie, Issy-les-Moulineaux, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Centre Psychiatrie et Neurosciences, Inserm Umr 894, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
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13
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Ashlesh P, Deepak KK, Preet KK. Role of prefrontal cortex during Sudoku task: fNIRS study. Transl Neurosci 2020; 11:419-427. [PMID: 33335780 PMCID: PMC7718610 DOI: 10.1515/tnsci-2020-0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background Sudoku is a popular cognitively stimulating leisure-time activity. Many studies have been directed toward finding an algorithm to solve Sudoku, but the investigation of the neural substrates involved in Sudoku has been challenging. Methods Sudoku task was divided into two steps to understand the differential function of the prefrontal cortex (PFC) while applying heuristic rules. PFC activity was recorded at 16 optode locations using functional near infrared spectroscopy. Classical two-way analysis of variance as well as general linear model-based approach was used to analyze the data from 28 noise-free recordings obtained from right-handed participants. Results Post hoc analysis showed a significant increase in oxyhemoglobin concentrations and decrease in deoxyhemoglobin concentrations at all 16 optode locations during step 1 (3 × 3 subgrids) and step 2 (easy level 9 × 9 Sudoku) when compared with the rest (p < 0.0001). Contrasting the step 2 - step 1 revealed that medial regions of PFC were preferentially activated. Conclusion Both the medial and lateral regions of PFC are activated during Sudoku task. However, the medial regions of PFC play a differential role, especially when we consider searching and selecting the heuristic rules. Thus, Sudoku may be used for cognitive remediation training in neuropsychiatric disorders involving PFC.
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Affiliation(s)
- Patil Ashlesh
- Department of Physiology, All India Institute of Medical Sciences, Nagpur, India
| | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kochhar Kanwal Preet
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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14
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Abraham J, Meng A, Siraco S, Kannampallil T, Politi MC, Baumann AA, Lenze EJ, Avidan MS. A Qualitative Study of Perioperative Depression and Anxiety in Older Adults. Am J Geriatr Psychiatry 2020; 28:1107-1118. [PMID: 32234274 DOI: 10.1016/j.jagp.2020.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We had three aims 1) understand barriers to perioperative management of anxiety and depression in older surgical patients; 2) identify preferences and requirements for interventions to manage their anxiety and depression; and 3) explore the feasibility of implementing such interventions in perioperative care. DESIGN A qualitative study using semistructured interviews was conducted. SETTING Participants were recruited at a large academic medical center. PARTICIPANTS We interviewed older surgical patients and clinicians to characterize their perspectives on management of anxiety and depression symptoms, with emphasis on patient needs, barriers, and potential interventions to address these needs. MEASUREMENTS We used the Consolidated Framework for Intervention Research to guide the development of interview questions related to intervention implementation feasibility. Thematic analysis was used to analyze interview responses. RESULTS Forty semistructured interviews were conducted. Key barriers for perioperative management of depression and anxiety included fear of surgery, acute pain, postoperative neurocognitive disorders, limited understanding of what to expect regarding surgery and recovery, and overwhelmingly complex medication management. Patients and clinicians suggested that a bundled mental health management intervention targeted for older surgical patient population comprised of behavioral and pharmacologic strategies can help mitigate anxiety and depression symptoms during the perioperative period. Clinicians emphasized the need for a collaborative engagement strategy that includes multiple stakeholders in the design, planning, and implementation of such an intevention. CONCLUSION New care models need to be developed to integrate mental health care into the current perioperative care practice.
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Affiliation(s)
- Joanna Abraham
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO; Institute for Informatics, School of Medicine, Washington University (JA, TK), St. Louis, MO.
| | - Alicia Meng
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO
| | - Susan Siraco
- School of Medicine, St. Louis University (SS), St. Louis, MO
| | - Thomas Kannampallil
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO; Institute for Informatics, School of Medicine, Washington University (JA, TK), St. Louis, MO
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery (MCP), School of Medicine, Washington University, St. Louis, MO
| | - Ana A Baumann
- George Warren Brown School of Social Work, Washington University (AAB), St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EJL), School of Medicine, Washington University, St. Louis, MO
| | - Michael S Avidan
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO
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15
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Keynejad RC, Bitew T, Sorsdahl K, Myers B, Honikman S, Medhin G, Deyessa N, Sevdalis N, Tol WA, Howard L, Hanlon C. Problem solving therapy (PST) tailored for intimate partner violence (IPV) versus standard PST and enhanced usual care for pregnant women experiencing IPV in rural Ethiopia: protocol for a randomised controlled feasibility trial. Trials 2020; 21:454. [PMID: 32487250 PMCID: PMC7268746 DOI: 10.1186/s13063-020-04331-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/19/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In rural Ethiopia, 72% of women are exposed to lifetime intimate partner violence (IPV); IPV is most prevalent during pregnancy. As well as adversely affecting women's physical and mental health, IPV also increases the risk of child morbidity and mortality associated with maternal depression, thus making antenatal care an important opportunity for intervention. Adapting generic, task-shared, brief psychological interventions for perinatal depression and anxiety to address the needs and experiences of women affected by IPV may improve acceptability to women and feasibility for health workers. This randomised controlled feasibility trial will compare brief problem solving therapy (PST) specifically adapted for pregnant women experiencing IPV (PST-IPV) with standard PST and enhanced usual care to determine the feasibility of a future fully powered randomised controlled trial. METHODS Seventy-five pregnant women scoring five or more on the Patient Health Questionnaire, endorsing a tenth question about functional impact and reporting past-year IPV, will be recruited from antenatal care clinics in predominantly rural districts in Ethiopia. Consenting participants will be randomised to either four sessions of PST-IPV, four sessions of standard PST or information about sources of support (enhanced usual care) in a three-arm design. The interventions will be delivered by trained, supervised antenatal care staff using a task-sharing model. Assessments will be made at baseline and after 9 weeks by masked outcome assessors and will include measures of depression symptoms (primary outcome), post-traumatic stress, anxiety symptoms, functional impact, past-month IPV and hypothesised mediators (secondary outcomes). A mixed-method process evaluation will determine the feasibility of a future randomised controlled trial, assess the feasibility, acceptability, fidelity and quality of implementation of PST-IPV, generate testable hypotheses about causal mechanisms, and identify potential contextual factors influencing outcomes. DISCUSSION Despite mental health being a critical concern for women experiencing IPV, there is limited evidence for brief, task-shared psychological interventions adapted for their needs in low- and middle-income countries. Contextually tailored interventions for pregnant women experiencing IPV in low- and middle-income countries require development and process evaluation. This randomised controlled feasibility trial will yield results on the feasibility of conducting a fully powered trial, relevant to researchers, primary and antenatal care clinicians in resource-limited settings. TRIAL REGISTRATION Pan-African clinical trials registry: PACTR202002513482084. Prospectively registered on 13 December 2019.
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Affiliation(s)
- Roxanne C. Keynejad
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Tesera Bitew
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Educational and Behavioural Science, Debre Markos University, Debre Markos, Ethiopia
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol Tobacco and Other Drug Use Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Girmay Medhin
- Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Wietse A. Tol
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- United States of America (USA) & Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, New York, NY USA
| | - Louise Howard
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- World Health Organization Collaborating Centre for Mental Health Research and Capacity-Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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16
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Cuijpers P, van Straten A, Warmerdam L. Problem solving therapies for depression: A meta-analysis. Eur Psychiatry 2020; 22:9-15. [PMID: 17194572 DOI: 10.1016/j.eurpsy.2006.11.001] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 11/01/2006] [Accepted: 11/03/2006] [Indexed: 11/15/2022] Open
Abstract
AbstractPurposeIn the past decades, the effects of problem-solving therapy (PST) for depression have been examined in several randomized controlled studies. However, until now no meta-analysis has tried to integrate the results of these studies.MethodsWe conducted a systematic literature search and identified 13 randomized studies examining the effects of PST, with a total of 1133 subjects. The quality of studies varied.ResultsThe mean standardized effect size was 0.34 in the fixed effects model and 0.83 in the random effects model, with very high heterogeneity. Subgroup analyses indicated significantly lower effects for individual interventions in studies with subjects who met criteria for major depression, studies in which intention-to-treat analyses were conducted instead of completers-only analyses, and studies with pill placebo and care-as-usual control groups. Heterogeneity was high, and the subgroup analyses did not result in clear indications of what caused this high heterogeneity. This indicates that PST has varying effects on depression, and that it is not known to date what determines whether PST has larger of smaller effects.ConclusionAlthough there is no doubt that PST can be an effective treatment for depression, more research is needed to ascertain the conditions and subjects in which these positive effects are realized.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
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17
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Westerhof GJ, Slatman S. In search of the best evidence for life review therapy to reduce depressive symptoms in older adults: A meta-analysis of randomized controlled trials. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/cpsp.12301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Dunphy K, Baker FA, Dumaresq E, Carroll-Haskins K, Eickholt J, Ercole M, Kaimal G, Meyer K, Sajnani N, Shamir OY, Wosch T. Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms. Front Psychol 2019; 9:2655. [PMID: 30671000 PMCID: PMC6331422 DOI: 10.3389/fpsyg.2018.02655] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/10/2018] [Indexed: 01/26/2023] Open
Abstract
Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music modalities, are utilized internationally to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama, and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g., increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g., enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g., creative expression, aesthetic pleasure), cognitive (e.g., stimulation of memory), and social (e.g., increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research includes stronger focus on testing of processes and mechanisms.
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Affiliation(s)
- Kim Dunphy
- Creative Arts and Music Therapy Research Unit, University of Melbourne, Melbourne, VIC, Australia
| | - Felicity A. Baker
- Creative Arts and Music Therapy Research Unit, University of Melbourne, Melbourne, VIC, Australia
| | - Ella Dumaresq
- Creative Arts and Music Therapy Research Unit, University of Melbourne, Melbourne, VIC, Australia
| | - Katrina Carroll-Haskins
- Health, Arts, Learning & Evaluation Lab, Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Jasmin Eickholt
- Creative Arts and Music Therapy Research Unit, University of Melbourne, Melbourne, VIC, Australia
- Music Therapy Lab, Faculty of Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Maya Ercole
- Creative Arts and Music Therapy Research Unit, University of Melbourne, Melbourne, VIC, Australia
| | - Girija Kaimal
- Health, Arts, Learning & Evaluation Lab, Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Kirsten Meyer
- Creative Arts and Music Therapy Research Unit, University of Melbourne, Melbourne, VIC, Australia
| | - Nisha Sajnani
- Theatre and Health Lab, Department of Music and Performing Arts Professions, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, United States
| | - Opher Y. Shamir
- Theatre and Health Lab, Department of Music and Performing Arts Professions, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, United States
| | - Thomas Wosch
- Music Therapy Lab, Faculty of Applied Social Sciences, University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
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19
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Rubin A, Parrish DE, Miyawaki CE. Benchmarks for Evaluating Life Review and Reminiscence Therapy in Alleviating Depression among Older Adults. SOCIAL WORK 2019; 64:61-72. [PMID: 30428074 DOI: 10.1093/sw/swy054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 09/11/2018] [Indexed: 06/09/2023]
Abstract
The efficacy of reminiscence and life review (LR) therapy in alleviating depression among older adults is well established. However, providers in nonresearch settings might implement these interventions inadequately, and such settings rarely can evaluate their outcomes using control groups. Alternatively, evaluators in such settings can calculate a within-group effect size and then compare it with average within-group effect size benchmarks derived from the randomized clinical trials (RCTs) supporting the intervention's effectiveness. This study developed these within-group effect size benchmarks. A search of RCTs from five systematic reviews and meta-analyses, and more recent RCTs published through 2016, yielded 25 studies that met inclusion criteria. Hedge's g for LR recipients and waitlist controls were .598 and -.20, respectively, and .568 and -.012 for reminiscence theory. These benchmarks offer an approach for evaluating the implementation of LR and reminiscence therapy when control groups are infeasible.
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Affiliation(s)
- Allen Rubin
- Allen Rubin, PhD, is professor, Graduate College of Social Work, University of Houston, 110HA Social Work Building-Room 342, Houston, TX 77024-4013; e-mail: . Danielle E. Parrish, PhD, is associate professor, Diana R. Garland School of Social Work, Baylor University, Houston. Christina E. Miyawaki, PhD, is assistant professor, Graduate College of Social Work, University of Houston
| | - Danielle E Parrish
- Allen Rubin, PhD, is professor, Graduate College of Social Work, University of Houston, 110HA Social Work Building-Room 342, Houston, TX 77024-4013; e-mail: . Danielle E. Parrish, PhD, is associate professor, Diana R. Garland School of Social Work, Baylor University, Houston. Christina E. Miyawaki, PhD, is assistant professor, Graduate College of Social Work, University of Houston
| | - Christina E Miyawaki
- Allen Rubin, PhD, is professor, Graduate College of Social Work, University of Houston, 110HA Social Work Building-Room 342, Houston, TX 77024-4013; e-mail: . Danielle E. Parrish, PhD, is associate professor, Diana R. Garland School of Social Work, Baylor University, Houston. Christina E. Miyawaki, PhD, is assistant professor, Graduate College of Social Work, University of Houston
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20
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De Sousa A, Lodha P. Reminiscence therapy in geriatric mental health care: A clinical review. JOURNAL OF GERIATRIC MENTAL HEALTH 2019. [DOI: 10.4103/jgmh.jgmh_1_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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21
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Rodrigues J, Capuano AW, Barnes LL, Bennett DA, Shah RC. Effect of Antidepressant Medication Use and Social Engagement on the Level of Depressive Symptoms in Community-Dwelling, Older African Americans and Whites With Dementia. J Aging Health 2018; 31:1278-1296. [PMID: 29742953 PMCID: PMC6212324 DOI: 10.1177/0898264318772983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: This study examines the effect of antidepressant medication use and social engagement on the level of depressive symptoms at the time of initially meeting criteria for dementia. Method: Measures of social engagement, medication use, and depressive symptoms from 402 participants with incident dementia were utilized for the study. Proportional odds models adjusted for demographics were constructed with depressive symptoms as the outcome and social network size, perceived social isolation, and antidepressant medication use as independent variables. Results: Each additional person in the social network was associated with a lower depressive symptom score, odds ratio (OR) = 0.93, 95% confidence interval (CI) = [0.90, 0.97], p ≤ .01, and each unit increase in perceived social isolation was associated with a higher depressive symptom score (OR = 4.14, 95% CI = [2.94, 5.85], p ≤ .01). No association was found between antidepressant medication use and depressive symptom score. Discussion: Depression management at the time of dementia diagnosis should probably be directed toward increasing social engagement in older adults.
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22
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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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Abstract
The role of the general adult psychiatrist has changed significantly over the past decade. There is a focus (almost exclusively in some cases) on the management of patients with severe mental illness. Within the multi-disciplinary team, the key role of the psychiatrist is often perceived as the management of medication, making decisions about clinical risk and acting as gatekeeper to often restricted in-patient beds. Psychological and social interventions are commonly seen as the remit of other members of the team. Although psychiatric training should equip psychiatrists to have at least a reasonable understanding and practical knowledge of psychological treatments, many consultants in their day-to-day practice do not have sufficient time to utilise such treatments. These factors brought together result in a situation where the practice of many general adult psychiatrists is almost exclusively the treatment of patients with severe illness and within the treatment of such patients, psychiatric practice is much more about medication and risk management than the personal implementation of psychological interventions.
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Abstract
Both antidepressants and psychological treatments are effective in the management of late-life depression. Nevertheless, there remains a considerable challenge to improve the prognosis for depression in older people. Endlessly increasing the range of antidepressants does not seem to be the answer, so attention is turning to new combinations of treatments and new ways of delivering care and improving treatment uptake. Collaboration between specialist and primary care, case management and multifaceted interventions are currently the most exciting prospects. There is good evidence for the role of both medication and psychological treatment in keeping the patient well after recovery.
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Beaman A, Pushkar D, Etezadi S, Bye D, Conway M. Autobiographical Memory Specificity Predicts Social Problem-Solving Ability in Old and Young Adults. Q J Exp Psychol (Hove) 2018; 60:1275-88. [PMID: 17676558 DOI: 10.1080/17470210600943450] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Based on recent research with young, depressed adults, age-related cognitive declines and decreased autobiographical specificity were hypothesized to predict poorer social problem-solving ability in older than in younger healthy adults. Priming autobiographical memory (ABM) was hypothesized to improve social problem-solving performance for older adults. Subsequent to cognitive tests, old and young participants’ specific ABMs were tested using a cued recall task, followed by a social problem-solving task. The order of the tasks was counterbalanced to test for a priming effect. Autobiographical specificity was related to cognitive ability and predicted social problem-solving ability for both age groups. However, priming of ABM did not improve social problem-solving ability for older or younger adults. This study provides support for the hypothesis that autobiographical memory serves a directive function across the life-span.
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Affiliation(s)
- Amanda Beaman
- Centre for Research in Human Development, Concordia University, Montreal, Quebec, Canada.
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Jamin G, Luyten T, Delsing R, Braun S. The process of co-creating the interface for VENSTER, an interactive artwork for nursing home residents with dementia. Disabil Rehabil Assist Technol 2017; 13:809-818. [PMID: 29037109 DOI: 10.1080/17483107.2017.1385102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Interactive art installations might engage nursing home residents with dementia. The main aim of this article was to describe the challenging design process of an interactive artwork for nursing home residents, in co-creation with all stakeholders and to share the used methods and lessons learned. This process is illustrated by the design of the interface of VENSTER as a case. METHODS Nursing home residents from the psychogeriatric ward, informal caregivers, client representatives, health care professionals and members of the management team were involved in the design process, which consisted of three phases: (1) identify requirements, (2) develop a prototype and (3) conduct usability tests. Several methods were used (e.g. guided co-creation sessions, "Wizard of Oz"). Each phase generated "lessons learned", which were used as the departure point of the next phase. RESULTS Participants hardly paid attention to the installation and interface. There, however, seemed to be an untapped potential for creating an immersive experience by focussing more on the content itself as an interface (e.g. creating specific scenes with cues for interaction, scenes based on existing knowledge or prior experiences). "Fifteen lessons learned" which can potentially assist the design of an interactive artwork for nursing home residents suffering from dementia were derived from the design process. CONCLUSIONS This description provides tools and best practices for stakeholders to make (better) informed choices during the creation of interactive artworks. It also illustrates how co-design can make the difference between designing a pleasurable experience and a meaningful one. Implications for rehabilitation Co-design with all stakeholders can make the difference between designing a pleasurable experience and a meaningful one. There seems to be an untapped potential for creating an immersive experience by focussing more on the content itself as an interface (e.g. creating specific scenes with cues for interaction, scenes based on existing knowledge or prior experiences). Content as an interface proved to be a crucial part of the overall user experience. The case-study provides tools and best practices (15 "lessons learned") for stakeholders to make (better) informed choices during the creation of interactive artworks.
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Affiliation(s)
- Gaston Jamin
- a Maastricht Academy of Media, Design and Technology, Arts Faculty Maastricht , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,b Expertise Centre for Innovative Care and Technology (EIZT) , Research Program "Stimulating Healthy Active Lifestyle" , Heerlen , The Netherlands
| | - Tom Luyten
- a Maastricht Academy of Media, Design and Technology, Arts Faculty Maastricht , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,c Research Centre for Technology in Care , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,f Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Rob Delsing
- a Maastricht Academy of Media, Design and Technology, Arts Faculty Maastricht , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,d Faculty of Arts , Research Centre for Technology Driven Art , Zuyd University of Applied Sciences , Maastricht , The Netherlands
| | - Susy Braun
- b Expertise Centre for Innovative Care and Technology (EIZT) , Research Program "Stimulating Healthy Active Lifestyle" , Heerlen , The Netherlands.,e Faculty of Health , Research Centre for Nutrition, Lifestyle and Exercise , Zuyd University of Applied Sciences , Heerlen , The Netherlands.,f Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
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Stahl ST, Albert SM, Dew MA, Anderson S, Karp JF, Gildengers AG, Butters MA, Reynolds CF. Measuring Participant Effort in a Depression Prevention Trial: Who Engages in Problem-Solving Therapy? Am J Geriatr Psychiatry 2017; 25:909-916. [PMID: 28410857 PMCID: PMC5724523 DOI: 10.1016/j.jagp.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the acceptability of clinical interventions for depression prevention, identification of clinical characteristics associated with intervention engagement is needed. The purpose of this study is to describe levels and correlates of participant engagement in Problem Solving Therapy (PST) in adults 60 and older with subthreshold depression. METHODS As part of a clinical trial to prevent depression among older adults with subthreshold depression, participants who were randomized to receive PST completed 6-8 sessions in which they learned skills to solve self-selected problems that were contributing to stress and reduced quality of life. To measure participants' engagement with PST, interventionists completed 3 scales that rated participants' level of participation in problem solving activities, understanding of the multistep process of PST, and between-session homework effort. Using logistic regression, we examined whether physical health, level of cognitive function, gait speed, and disability served as correlates of engagement in the PST intervention. RESULTS Gait speed, a measure of physical and cognitive health, was significantly associated with engagement in PST. Participants who walked faster were more likely to engage with PST compared to participants who walked more slowly. No other baseline variables were significant correlates. CONCLUSIONS Older adults who walk more slowly may need alternative delivery methods to fully engage in PST. Gait speed reflects physical and cognitive health, and predicts frailty, disability, and psychomotor speed slowing. For these reasons, gait speed may be a marker for factors that will serve to predict poorer engagement in psychosocial interventions like PST.
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Anguera JA, Gunning FM, Areán PA. Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial. Depress Anxiety 2017; 34:508-517. [PMID: 28052513 PMCID: PMC6093618 DOI: 10.1002/da.22588] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/14/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol. METHODS In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard. RESULTS EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence. CONCLUSIONS This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings.
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Affiliation(s)
- Joaquin A. Anguera
- Department of Neurology, University of California, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Faith M. Gunning
- Department of Psychiatry, Weil Cornell Medicine, New York, NY, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington
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Stahl ST, Rodakowski J, Gildengers AG, Reynolds CF, Morse JQ, Rico K, Butters MA. Treatment Considerations for Depression Research in Older Married Couples: A Dyadic Case Study. Am J Geriatr Psychiatry 2017; 25:388-395. [PMID: 28237826 PMCID: PMC5724521 DOI: 10.1016/j.jagp.2016.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Critical gaps remain in understanding optimal approaches to intervening with older couples. The focus of this report is to describe the pros and cons of incorporating spousal dyads into depression-prevention research. METHODS In an intervention development study, the authors administered problem-solving therapy (PST) dyadically to participants with mild cognitive impairment (MCI) and their caregivers. Dyads worked with the same interventionist in the same therapy session. The dyadic PST (highlighted in a case example of a husband with MCI and his wife/support person) and the potential feasibility of the program are described. RESULTS The authors found that the wife of the individual with MCI could be trained as a PST coach to help her husband learn and use problem-solving skills. A decrease in depressive symptom severity was observed for the individual with MCI, which was sustained over 12 months of follow-up. Neither the husband nor wife experienced an incident episode of major depression over the course of the study. CONCLUSION Dyadic interventions need to be further developed in geriatric psychiatry; proven methods such as PST can be modified to include patients' support persons. Recommendations are offered for developing randomized controlled trials that aim to recruit dyads and prevent depression in at-risk older married couples.
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Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer Q Morse
- Department of Counseling Psychology, Chatham University, Pittsburgh, PA
| | - Kevin Rico
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Autobiographical episodic memory-based training for the treatment of mood, anxiety and stress-related disorders: A systematic review and meta-analysis. Clin Psychol Rev 2016; 52:92-107. [PMID: 28086133 DOI: 10.1016/j.cpr.2016.12.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/28/2016] [Accepted: 12/15/2016] [Indexed: 11/21/2022]
Abstract
We review evidence for training programmes that manipulate autobiographical processing in order to treat mood, anxiety, and stress-related disorders, using the GRADE criteria to judge evidence quality. We also position the current status of this research within the UK Medical Research Council's (2000, 2008) framework for the development of novel interventions. A literature search according to PRISMA guidelines identified 15 studies that compared an autobiographical episodic memory-based training (AET) programme to a control condition, in samples with a clinician-derived diagnosis. Identified AET programmes included Memory Specificity Training (Raes, Williams, & Hermans, 2009), concreteness training (Watkins, Baeyens, & Read, 2009), Competitive Memory Training (Korrelboom, van der Weele, Gjaltema, & Hoogstraten, 2009), imagery-based training of future autobiographical episodes (Blackwell & Holmes, 2010), and life review/reminiscence therapy (Arean et al., 1993). Cohen's d was calculated for between-group differences in symptom change from pre- to post-intervention and to follow-up. We also completed meta-analyses for programmes evaluated across multiple studies, and for the overall effect of AET as a treatment approach. Results demonstrated promising evidence for AET in the treatment of depression (d=0.32), however effect sizes varied substantially (from -0.18 to 1.91) across the different training protocols. Currently, research on AET for the treatment of anxiety and stress-related disorders is not yet at a stage to draw firm conclusions regarding efficacy as there were only a very small number of studies which met inclusion criteria. AET offers a potential avenue through which low-intensity treatment for affective disturbance might be offered.
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Abstract
Social cognitive variables are salient factors in the prevention, development, and maintenance of health-related problems. These variables are of particular interest to counseling psychologists, as they are amenable to a variety of psychological interventions. We review several social-cognitive processes that have been studied in relation to behavioral health and health-related problems. We then discuss implications for assessment and theory-based interventions.
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Gildengers AG, Butters MA, Albert SM, Anderson SJ, Dew MA, Erickson K, Garand L, Karp JF, Lockovich MH, Morse J, Reynolds CF. Design and Implementation of an Intervention Development Study: Retaining Cognition While Avoiding Late-Life Depression (ReCALL). Am J Geriatr Psychiatry 2016; 24:444-54. [PMID: 27066730 PMCID: PMC4871778 DOI: 10.1016/j.jagp.2015.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To discuss the design, rationale, and implementation of an intervention development study addressing indicated and selective prevention of depression and anxiety in individuals 60 years and older with mild cognitive impairment (MCI) and in their caregivers. METHODS In Phase I, now completed, we developed and standardized problem-solving therapy (PST) and the combined PST + moderate-intensity physical exercise (PE) intervention to be administered to participants with MCI and their caregivers together, dyadically, with both participants working with the same interventionist in the same therapy sessions. In Phase II we have been testing the interventions against enhanced usual care (EUC) and have addressed challenges to recruitment. Randomization was to one of three cells: PST + PE, PST, or EUC. RESULTS Although we set out to intervene dyadically, many individuals with MCI lived alone or did not have a support person who could participate in the study with them. Consequently, we modified the study to include MCI participants with and without support persons. Ninety-four participants were enrolled: 20 with MCI together with their support persons (N = 20 dyads) and 54 MCI participants without accompanying support persons. Most participants have been satisfied with the usefulness of the interventions in managing stress and cognitive problems. CONCLUSION PST and moderate-intensity PE are acceptable interventions for depression and anxiety prevention in older adults with MCI and their available caregivers.
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Affiliation(s)
- Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Stewart J Anderson
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kirk Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Linda Garand
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael H Lockovich
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer Morse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults. Int J Geriatr Psychiatry 2016; 31:526-35. [PMID: 26437368 DOI: 10.1002/gps.4358] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) affects many older adults and is associated with poor medical and mental health outcomes. Problem Solving Therapy (PST) has emerged as a promising psychotherapy for MDD in older adults, although the efficacy of PST in this population has not been well described. We examined the effectiveness of PST for the treatment of MDD in older adults in a systematic review and meta-analysis. METHODS We searched electronic databases to identify randomized controlled trials comparing PST to a control condition or other treatment for MDD in adults with an average age of 60 years or older. We used meta-analysis to arrive at pooled summary measures of the efficacy of PST when compared to control conditions on the change in depressive symptoms and other outcomes. RESULTS Nine studies with a total of 569 participants (290 PST, 279 control) met inclusion criteria. Most studies administered PST in person and were between 6 and 12 weeks in duration. Meta-analysis of six studies evaluating the effect of PST on depression using the Hamilton Rating Scale for Depression identified a significant reduction in depression associated with PST (pooled mean difference = -6.94, 95%CI -10.91 to -2.97, d = 1.15, P = 0.0006). PST was also effective in reducing disability in studies reporting this outcome. CONCLUSIONS Our review supports the existing research literature on PST suggesting that it is an effective treatment for older people with MDD. Further study is required to understand long-term outcomes associated with PST and its efficacy when compared to other treatments.
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Affiliation(s)
- Julia G Kirkham
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
| | - Namkee Choi
- School of Social Work, University of Texas at Austin, TX, USA
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
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Tyler E, Lobban F, Sutton C, Depp C, Johnson S, Laidlaw K, Jones SH. Feasibility randomised controlled trial of Recovery-focused Cognitive Behavioural Therapy for Older Adults with bipolar disorder (RfCBT-OA): study protocol. BMJ Open 2016; 6:e010590. [PMID: 26940112 PMCID: PMC4785318 DOI: 10.1136/bmjopen-2015-010590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/05/2016] [Accepted: 01/19/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Bipolar disorder is a severe and chronic mental health problem that persists into older adulthood. The number of people living with this condition is set to rise as the UK experiences a rapid ageing of its population. To date, there has been very little research or service development with respect to psychological therapies for this group of people. METHODS AND ANALYSIS A parallel two-arm randomised controlled trial comparing a 14-session, 6-month Recovery-focused Cognitive-Behavioural Therapy for Older Adults with bipolar disorder (RfCBT-OA) plus treatment as usual (TAU) versus TAU alone. Participants will be recruited in the North-West of England via primary and secondary mental health services and through self-referral. The primary objective of the study is to evaluate the feasibility and acceptability of RfCBT-OA; therefore, a formal power calculation is not appropriate. It has been estimated that randomising 25 participants per group will be sufficient to be able to reliably determine the primary feasibility outcomes (eg, recruitment and retention rates), in line with recommendations for sample sizes for feasibility/pilot trials. Participants in both arms will complete assessments at baseline and then every 3 months, over the 12-month follow-up period. We will gain an estimate of the likely effect size of RfCBT-OA on a range of clinical outcomes and estimate parameters needed to determine the appropriate sample size for a definitive, larger trial to evaluate the effectiveness and cost-effectiveness of RfCBT-OA. Data analysis is discussed further in the Analysis section in the main paper. ETHICS AND DISSEMINATION This protocol was approved by the UK National Health Service (NHS) Ethics Committee process (REC ref: 15/NW/0330). The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and local, participating NHS trusts. TRIAL REGISTRATION NUMBER ISRCTN13875321; Pre-results.
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Affiliation(s)
- Elizabeth Tyler
- Division of Health Research, The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Fiona Lobban
- Division of Health Research, The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Chris Sutton
- Lancashire Clinical Trials Unit, College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Colin Depp
- Department of Psychiatry, School of Medicine of the University of California, San Diego, San Diego, California, USA
| | - Sheri Johnson
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Ken Laidlaw
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Steven H Jones
- Division of Health Research, The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
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Alexopoulos GS, Raue PJ, McCulloch C, Kanellopoulos D, Seirup JK, Sirey JA, Banerjee S, Kiosses DN, Areán PA. Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial. Am J Geriatr Psychiatry 2016; 24:50-59. [PMID: 25794636 PMCID: PMC4539297 DOI: 10.1016/j.jagp.2015.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the hypotheses that (1) clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in reducing depressive symptoms of depressed, disabled, impoverished patients and that (2) development of problem-solving skills mediates improvement of depression. METHODS This randomized clinical trial with a parallel design allocated participants to CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Two hundred seventy-one individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST. Participants were at least 60 years old with major depression measured with the 24-item Hamilton Depression Rating Scale (HAM-D), had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. RESULTS CM and CM-PST led to similar declines in HAM-D over 12 weeks (t = 0.37, df = 547, p = 0.71); CM was noninferior to CM-PST. The entire study group (CM plus CM-PST) had a 9.6-point decline in HAM-D (t = 18.7, df = 547, p <0.0001). The response (42.5% versus 33.3%) and remission (37.9% versus 31.0%) rates were similar (χ(2) = 1.5, df = 1, p = 0.22 and χ(2) = 0.9, df = 1, p = 0.34, respectively). Development of problem-solving skills did not mediate treatment outcomes. There was no significant increase in depression between the end of interventions and 12 weeks later (0.7 HAM-D point increase) (t = 1.36, df = 719, p = 0.17). CONCLUSION Organizations offering CM are available across the nation. With training in CM, their social workers can serve the many depressed, disabled, low-income patients, most of whom have poor response to antidepressants even when combined with psychotherapy.
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Affiliation(s)
| | - Patrick J Raue
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Joanna K Seirup
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Samprit Banerjee
- Department of Public Health, Weill Cornell Medical College, White Plains, NY
| | - Dimitris N Kiosses
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Patricia A Areán
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
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Gustavson KA, Alexopoulos GS, Niu GC, McCulloch C, Meade T, Arean PA. Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction. Am J Geriatr Psychiatry 2016; 24:11-17. [PMID: 26743100 PMCID: PMC5730069 DOI: 10.1016/j.jagp.2015.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To test the hypothesis that Problem Solving Therapy (PST) is more effective than Supportive Therapy (ST) in reducing suicidal ideation in older adults with major depression and executive dysfunction. We further explored whether patient characteristics, such as age, sex, and additional cognitive impairment load (e.g., memory impairments) were related to changes in suicidal ideation over time. DESIGN Secondary data analysis using data from a randomized clinical trial allocating participants to PST or ST at 1:1 ratio. Raters were blind to patients' assignments. SETTING University medical centers. PARTICIPANTS 221 people aged 65 years old and older with major depression determined by Structured Clinical Interview for DSM-III-R diagnosis and executive dysfunction as defined by a score of 33 or less on the Initiation-Perseveration Score of the Mattis Dementia Rating Scale or a Stroop Interference Task score of 25 or less. INTERVENTIONS 12 weekly sessions of PST or ST. MAIN OUTCOME MEASURES The suicide item of the Hamilton Depression Rating Scale. RESULTS Of the 221 participants, 61% reported suicidal ideation (SI). The ST group had a lower rate of improvement in SI after 12 weeks (44.6%) than did the PST group (60.4%, Fisher's exact test p = 0.031). Logistic regression showed significantly greater reductions in SI in elders who received PST at both 12 weeks (OR: .50, Z = -2.16, p = 0.031) and 36 weeks (OR: 0.5, Z = -1.96, p = 0.05) after treatment. CONCLUSIONS PST is a promising intervention for older adults who are at risk for suicide. ClinicalTrials.gov Identifier: NCT00052091.
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Affiliation(s)
| | | | - Grace C. Niu
- University of California, San Francisco Department of Psychiatry
| | | | - Tanya Meade
- University of Western Sydney, School of Social Sciences and Psychology
| | - Patricia A. Arean
- University of Washington, Department of Psychiatry and Behavioral Sciences
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Areán PA, Raue PJ, McCulloch C, Kanellopoulos D, Seirup JK, Banerjee S, Kiosses DN, Dwyer E, Alexopoulos GS. Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults. Am J Geriatr Psychiatry 2015; 23:1307-1314. [PMID: 26628206 PMCID: PMC6033321 DOI: 10.1016/j.jagp.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability. METHODS Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used. RESULTS Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12. CONCLUSION CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865).
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Affiliation(s)
- Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Patrick J Raue
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Dora Kanellopoulos
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Joanna K Seirup
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Samprit Banerjee
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Dimitris N Kiosses
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Eleanor Dwyer
- San Mateo Department of Public Health, San Mateo, CA
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Sirey JA, Halkett A, Chambers S, Salamone A, Bruce ML, Raue PJ, Berman J. PROTECT: A Pilot Program to Integrate Mental Health Treatment Into Elder Abuse Services for Older Women. J Elder Abuse Negl 2015; 27:438-53. [PMID: 26331553 DOI: 10.1080/08946566.2015.1088422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of this pilot program was to test the usefulness of adapted Problem-Solving Therapy (PST) and anxiety management, called PROTECT, integrated into elder abuse services to reduce depression and improve self-efficacy. Depressed women victims were randomized to receive elder abuse resolution services combined with either PROTECT or a mental health referral. At follow-up, the PROTECT group showed greater reduction in depressive symptoms and endorsed greater improved self-efficacy in problem-solving when compared to those in the Referral condition. These preliminary findings support the potential usefulness of PROTECT to alleviate depressive symptoms and enhance personal resources among abused older women.
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Affiliation(s)
- Jo Anne Sirey
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Ashley Halkett
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Stephanie Chambers
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Aurora Salamone
- b New York City Department for the Aging , New York , New York , USA
| | - Martha L Bruce
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Patrick J Raue
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
| | - Jacquelin Berman
- b New York City Department for the Aging , New York , New York , USA
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Abstract
The response styles theory (Nolen-Hoeksema, 1991) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.
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Chippendale T, Boltz M. Living Legends: Effectiveness of a Program to Enhance Sense of Purpose and Meaning in Life Among Community-Dwelling Older Adults. Am J Occup Ther 2015; 69:6904270010p1-11. [DOI: 10.5014/ajot.2015.014894] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Living Legends program, which includes life review writing and an intergenerational exchange, compared with life review writing alone, for community-dwelling older adults.
METHOD. This study was a randomized controlled trial with a connected qualitative component. We analyzed quantitative data using independent-samples t tests and written descriptions of program experiences using Collaizi’s qualitative methodology; we then used a triangulation protocol to integrate the qualitative and quantitative data.
RESULTS. For participants in the writing workshop plus intergenerational exchange, sense of purpose and meaning in life increased significantly (p < .0001) compared with those in the writing workshop alone. Qualitative themes revealed additional program benefits.
CONCLUSION. Living Legends enhanced participants’ sense of purpose and meaning in life, a factor known to prevent cognitive loss and disability, compared with life review writing alone.
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Affiliation(s)
- Tracy Chippendale
- Tracy Chippendale, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York;
| | - Marie Boltz
- Marie Boltz, PhD, RN, GNP-BC, is Associate Professor, Boston College, William F. Connell School of Nursing, Chestnut Hill, MA
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Bains MK, Scott S, Kellett S, Saxon D. Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults. Aging Ment Health 2015; 18:1057-65. [PMID: 24903078 DOI: 10.1080/13607863.2014.908459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES There is a dearth of older adult evidence regarding the group treatment for co-morbid anxiety and depression. This research evaluated the effectiveness of a low-intensity group psychoeducational approach. METHOD Patients attended six sessions of a manualised cognitive-behavioural group. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and six-week follow-up from patients, who also rated the alliance and their anxiety/depression at each group session. Staff rated patients regarding their functioning at assessment, termination and six-week follow-up. Outcomes were categorised according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression. RESULTS Eight groups were completed with 34 patients, with a drop-out rate of 17%. Staff and patient rated outcome measures showed significant improvements (with small effect sizes) in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47%) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression with the alliance in groups stable over time. CONCLUSION The intervention evaluated shows clinical and organisational promise. The group approach needs to be further developed and tested in research with greater methodological control.
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Affiliation(s)
- Manreesh Kaur Bains
- a Older Adults Psychology , Sheffield Health & Social Care NHS Trust , Sheffield , United Kingdom
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Improvement in Depressive Symptoms Among Hispanic/Latinos Receiving a Culturally Tailored IMPACT and Problem-Solving Intervention in a Community Health Center. Community Ment Health J 2015; 51:385-92. [PMID: 25107309 PMCID: PMC4321971 DOI: 10.1007/s10597-014-9750-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/17/2014] [Indexed: 01/08/2023]
Abstract
The present study investigated whether a culturally-tailored problem-solving intervention delivered by a trained depression care specialist (DCS) would improve depressive symptoms over a 6 month period among Hispanic/Latino patients in a federally-qualified community health center by the California-Mexico border. Participants included 189 low income Hispanic/Latino patients of Mexican heritage. Based on the improving mood-promoting access to collaborative treatment (IMPACT) evidence-based treatment, patients received evidence-based problem-solving therapy. The Patient Health Questionnaire-9 (PHQ-9) was administered to assess changes in self-reported depressive symptoms between baseline and monthly for a 6-month follow up period. The majority of participants were female (72.5%) with a mean age of 52.5 (SD = 11.7). The mean PHQ-9 at baseline was 16.9 (SD = 4.0) and at the 6-month follow-up, the average PHQ-9 decreased to 9.9 (SD = 5.7). A linear mixed model analysis showed significant improvement in PHQ-9 scores over a 6 month period (F = 124.1; p < 0.001) after controlling for age, gender, smoking and diabetes. There was a significant three way interaction between time, gender and smoking (p = 0.01) showing that the depressive symptoms among male smokers did not improve as much as non-smoking males and females. Results suggest that a culturally-tailored problem solving approach can significantly reduce depressive symptoms among Hispanic/Latino low-income patients.
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Alexopoulos GS, Raue PJ, Kiosses DN, Seirup JK, Banerjee S, Arean PA. Comparing engage with PST in late-life major depression: a preliminary report. Am J Geriatr Psychiatry 2015; 23:506-13. [PMID: 25081818 PMCID: PMC4277491 DOI: 10.1016/j.jagp.2014.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/18/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The complexity of psychotherapies has been a barrier to community implementation. We used the Research Domain Criteria consensus as a guide to develop Engage, a streamlined, neurobiology-based psychotherapy for late-life depression that may match the skill set of practicing clinicians. This proof of concept study tested the hypotheses that Engage is bioequivalent to Problem Solving Therapy (PST) in reducing depressive symptoms, inducing remission, and ameliorating disability. METHODS Engage assumes that abnormal function of the positive valence systems fuels depression and uses "reward exposure" (engagement in meaningful, rewarding activities) as its principal intervention. Negativity bias, apathy, and emotional dysregulation are expressions of abnormalities in the negative valence, arousal and regulatory, and cognitive control systems, respectively. Engage targets each of them with simple interventions only if they interfere with reward exposure. We treated openly, with 9 weekly sessions of Engage, 39 older adults with unipolar major depression. We compared their course of depression (HAM-D), remission rate (HAM-D<10), and disability (WHODAS) with those of a historical comparison group (N = 97) treated with 9 weekly sessions of PST. RESULTS Community social workers and research therapists required one third as much training time in Engage as in PST. Engage was non-inferior to PST in reducing HAM-D and WHODAS. Remission rates for Engage at 6 and 9 weeks were 18.2% and 41.1%, respectively. The corresponding figures for PST were 13.7% and 35.0%, respectively. CONCLUSION These initial observations suggest that Engage has comparable efficacy with PST in reducing depressive symptoms and disability and warrants a randomized controlled trial.
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Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke. Am J Geriatr Psychiatry 2015; 23:477-87. [PMID: 25028344 PMCID: PMC4272675 DOI: 10.1016/j.jagp.2014.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 05/19/2014] [Accepted: 06/07/2014] [Indexed: 11/22/2022]
Abstract
Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.
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Sörensen S, White K, Mak W, Zanibbi K, Tang W, O'Hearn A, Hegel MT. The macular degeneration and aging study: Design and research protocol of a randomized trial for a psychosocial intervention with macular degeneration patients. Contemp Clin Trials 2015; 42:68-77. [PMID: 25812482 DOI: 10.1016/j.cct.2015.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/15/2015] [Accepted: 03/17/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Age-related Macular Degeneration (AMD) is the leading cause of irreversible and predictable blindness among older adults with serious physical and mental health consequences. Visual impairment is associated with negative future outlook and depression and has serious consequences for older adults' quality of life and, by way of depression, on long-term survival. Psychosocial interventions have the potential to alleviate and prevent depression symptoms among older AMD patients. METHODS We describe the protocol of the Macular Degeneration and Aging Study, a randomized clinical trial of a psychosocial Preventive Problem-Solving Intervention. The intervention is aimed at enhancing well-being and future planning among older adults with macular degeneration by increasing preparation for future care. RESULTS Adequate randomization and therapeutic fidelity were achieved. Current retention rates were acceptable, given the vulnerability of the population. Acceptability (adherence and satisfaction) was high. CONCLUSION Given the high public health significance and impact on quality of life among older adults with vision loss, this protocol contributes a valid test of a promising intervention for maintaining mental and physical health in this population.
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Affiliation(s)
- Silvia Sörensen
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, United States.
| | - Katherine White
- Association for the Blind and Visually Impaired, 100 South Clinton Avenue, Rochester, NY 14620, United States.
| | - Wingyun Mak
- Department of Psychology, Lehman College, 250 Bedford Park Blvd West, Bronx, NY 10468, United States.
| | - Katherine Zanibbi
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, United States.
| | - Wan Tang
- Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, United States.
| | - Amanda O'Hearn
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, United States.
| | - Mark T Hegel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, United States.
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Huang AX, Delucchi K, Dunn LB, Nelson JC. A systematic review and meta-analysis of psychotherapy for late-life depression. Am J Geriatr Psychiatry 2015; 23:261-73. [PMID: 24856580 DOI: 10.1016/j.jagp.2014.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/27/2014] [Accepted: 04/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the efficacy of psychotherapy in late-life depression and to determine the effect of the type of control group on the magnitude of psychotherapy effects. DESIGN A systematic review and meta-analysis of randomized controlled psychotherapy trials for late-life depression. SETTING Outpatient clinics or in subjects' home. PARTICIPANTS Subjects aged 55 years or older with acute-phase depressive disorder. MEASUREMENTS Change in depressive symptoms was measured with validated scales. Standardized mean differences (SMD) were calculated for each therapy-control contrast, as meta-analytic summaries for contrasts using a similar control, and for all contrasts combined. RESULTS The search identified 27 trials with 37 therapy-control contrasts and 2,245 subjects. Trials utilized five types of control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo). In the combined contrasts, psychotherapy was effective (SMD: 0.73; 95% confidence interval [CI]: 0.51, 0.95; z=6.42, p<0.00001). The SMD varied widely (from 0.05 to 1.36) and significantly (χ2=35.67, df=4, p<0.00001) between subgroups by type of control. In five trials that compared psychotherapy with supportive therapy, the SMD was 0.39 (95% CI: 0.16, 0.61; z=3.37, p<0.0007; I2=0%). The SMD was 0.11 within the waitlist controls and 1.10 within the supportive therapy subgroup. CONCLUSIONS Psychotherapy is effective for late-life depression, but the magnitude of the effect varies widely with the type of control group. Supportive therapy appears to best control for the nonspecific elements of psychotherapy and is associated with considerable change itself, but few trials have utilized it as a control.
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Affiliation(s)
- Alice X Huang
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA
| | - Kevin Delucchi
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA
| | - Laura B Dunn
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA; University of California, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - J Craig Nelson
- University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA.
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Sirey JA, Berman J, Salamone A, DePasquale A, Halkett A, Raeifar E, Banerjee S, Bruce ML, Raue PJ. Feasibility of integrating mental health screening and services into routine elder abuse practice to improve client outcomes. J Elder Abuse Negl 2015; 27:254-69. [PMID: 25611116 DOI: 10.1080/08946566.2015.1008086] [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] [Indexed: 10/24/2022]
Abstract
The goal of this pilot program was to test the feasibility of mental health screening among elder abuse victims and of offering those victims a brief psychotherapy for depression and anxiety. Elder abuse victims who sought assistance from a large, urban elder abuse service were screened for depression and anxiety using standardized measures. Clients with clinically significant depression (PHQ-9) or anxiety (GAD-7) were randomized to receive one of three different interventions concurrent with abuse resolution services. Staff were able to screen 315 individuals, with 34% of clients scoring positive for depression or anxiety. Of those with mental health needs, only 15% refused all services. The mental health intervention (PROTECT) was successfully implemented in two different formats with collaboration between staff workers. These findings support both the need for mental health care among elder abuse victims and the feasibility of integrating mental health screening and treatment into routine elder abuse practice.
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Affiliation(s)
- Jo Anne Sirey
- a Department of Psychiatry , Weill Cornell Medical College , White Plains , New York , USA
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Knöchel C, Alves G, Friedrichs B, Schneider B, Schmidt-Rechau A, Wenzlera S, Schneider A, Prvulovic D, Carvalho AF, Oertel-Knöchel V. Treatment-resistant Late-life Depression: Challenges and Perspectives. Curr Neuropharmacol 2015; 13:577-91. [PMID: 26467408 PMCID: PMC4761630 DOI: 10.2174/1570159x1305151013200032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 12/28/2022] Open
Abstract
The current Review article provides a narrative review about the neurobiological underpinnings and treatment of treatment resistant late-life depression (TRLLD). The manuscript focuses on therapeutic targets of late-life depression, which include pharmacological, psychological, biophysical and exercise treatment approaches. Therefore, we summarize available evidences on that kind of therapies for patients suffering from late-life depression. The search for evidences of therapeutic options of late-life depression were done using searching websites as "pubmed", and using the searching terms "depression", "late-life depression", "treatment", "biophysical therapy", "exercise therapy", "pharmacological therapy" and "psychological therapy". To the end, we summarize and discuss current data, providing some directions for further research. Treatment recommendations for elderly depressive patients favour a multimodal approach, containing psychological, pharmacological and secondary biophysical therapeutic options. Particularly, a combination of psychotherapy and antidepressant medication reflects the best therapeutic option. However, mostly accepted and used is the pharmacological treatment although evidence suggests that the drug therapy is not as effective as it is in younger depressive patients. Further studies employing larger samples and longer follow-up periods are necessary and may focus on comparability of study designs and involve novel approaches to establish the validity and reliability of multimodal treatment programs.
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Affiliation(s)
- Christian Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Gilberto Alves
- Center for Alzheimer’s Disease and Related Disorders, Universidade Federal, do Rio de Janeiro, Brazil
| | - Benedikt Friedrichs
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | | | - Anna Schmidt-Rechau
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Sofia Wenzlera
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Angelina Schneider
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - David Prvulovic
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - André F. Carvalho
- Center for Alzheimer’s Disease and Related Disorders, Universidade Federal, do Rio de Janeiro, Brazil
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
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Motter JN, Devanand DP, Doraiswamy PM, Sneed JR. Computerized Cognitive Training for Major Depressive Disorder: What's Next? Front Psychiatry 2015; 6:137. [PMID: 26483706 PMCID: PMC4589639 DOI: 10.3389/fpsyt.2015.00137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/15/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeffrey N Motter
- The Graduate Center, City University of New York , New York, NY , USA ; Queens College, City University of New York , New York, NY , USA
| | - Davangere P Devanand
- Columbia University and the New York State Psychiatric Institute , New York, NY , USA
| | | | - Joel R Sneed
- Queens College, City University of New York , New York, NY , USA ; Columbia University and the New York State Psychiatric Institute , New York, NY , USA
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Sachs-Ericsson N, Blazer DG. The new DSM-5 diagnosis of mild neurocognitive disorder and its relation to research in mild cognitive impairment. Aging Ment Health 2015; 19:2-12. [PMID: 24914889 DOI: 10.1080/13607863.2014.920303] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The Diagnostic Statistical Manual-5 (DSM-5) has included a category named the neurocognitive disorder which was formally known in DSM-IV as 'dementia, delirium, amnestic, and other cognitive disorders'. The DSM-5 distinguishes between 'mild' and 'major' neurocognitive disorders. Major neurocognitive disorder replaces the DSM-IV's term 'dementia or other debilitating conditions'. A pivotal addition is 'mild neurocognitive disorder (mNCD)' defined by a noticeable decrement in cognitive functioning that goes beyond normal changes seen in aging. It is a disorder that may progress to dementia - importantly, it may not. Presently, our understanding of mNCD is derived from research on mild cognitive impairment (MCI). Whereas there is currently no clear treatment for mNCD, many experimental therapies now and into the future will focus upon secondary prevention, namely decreasing the risk of progression to major NCD. In this article, we will focus on mNCD by reviewing the relevant literature on MCI. We will review the research on the incidence and prevalence of MCI, conversion rates from MCI to dementia, risk factors for conversion of MCI to dementia, comorbidity of MCI with other neuropsychiatric disorders (NPS), and the development of treatment strategies for neuropsychiatric disorders in MCI. The presence of NPS is common among individuals with MCI and is an important risk for progression to dementia. However, there has been little research on effective treatments for NPS in MCI. Clinicians and investigators must determine if the treatment of the NPS in mNCD will improve quality of life and help reduce the progression of the cognitive impairment.
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