1
|
Saberi S, Ahmadi R, Khakpoor S, Pirzeh R, Hasani M, Moradveisi L, Saed O. Comparing the effectiveness of behavioral activation in group vs. self-help format for reducing depression, repetitive thoughts, and enhancing performance of patients with major depressive disorder: a randomized clinical trial. BMC Psychiatry 2024; 24:516. [PMID: 39030505 PMCID: PMC11264713 DOI: 10.1186/s12888-024-05973-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/17/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Behavioral activation has gained increasing attention as an effective treatment for depression. However, the effectiveness of Behavioral Activation Group Therapy (BAGT) in controlled conditions compared to its self-help programs requires more investigation. The present study aimed to compare their effectiveness on depressive symptoms, repetitive negative thinking (RNT), and performance in patients with major depressive disorder (MDD). METHODS In this randomized clinical trial, 40 patients diagnosed with Major Depressive Disorder (MDD) were recruited based on a structured clinical interview for DSM-5 (SCID-5). Participants were allocated to BAGT (n = 20) and self-help behavioral activation (SBA; n = 20) groups. BAGT received ten weekly sessions (90 min), while the SBA group followed the same protocol as the self-help intervention. Participants were evaluated at pre-treatment, post-treatment, and the 2-month follow-up using the Beck Depression Inventory-II (BDI-II), repetitive thinking questionnaire (RTQ-31), and work and social adjustment scale (WSAS). RESULTS The results of a Mixed ANOVA analysis revealed that participants who underwent BAGT showed significant improvement in depression, rumination, work, and social functioning post-treatment and at the 2-month follow-up. However, the SBA group did not show significant changes in any outcome. The study also found that, based on clinical significance, 68% of the BAGT participants were responsive to treatment, and 31% achieved a high final performance status at the 2-month follow-up. DISCUSSION BAGT was more effective than SBA in MDD patients. Participants' engagement with self-help treatment is discussed. TRIAL REGISTRATION The present trial has been registered in the Iranian Registry of Clinical Trials Center (IRCT ID: IRCT20181128041782N1|| http://www.irct.ir/ ) (Registration Date: 04/03/2019).
Collapse
Affiliation(s)
- Soleiman Saberi
- Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Ahmadi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahel Khakpoor
- Department of Clinical Psychology, School of Behavioural Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Pirzeh
- Department of Psychiatry, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohsen Hasani
- Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Latif Moradveisi
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Omid Saed
- Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
| |
Collapse
|
2
|
Takele MD, Belay GJ, Kassa T, Merawie DM, Zinabu FS, Cherkos K, Eriku GA, Kibret AK, Chanie ST. Burden of depression and its associated factors among older people living in Gondar town, Ethiopia: a community based cross-sectional study. Aging Ment Health 2024:1-8. [PMID: 38952219 DOI: 10.1080/13607863.2024.2372056] [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: 01/16/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES Depression is one of the main causes of disability worldwide and makes a major contribution to the global disease burden, especially in developing countries. It is also one of the most prevalent psychiatric disorders in the older people and a significant risk factor for both disability and death. Despite the fact that little research has been done on it among those who live in sub-Saharan Africa, especially Ethiopia, the aim of this study was to fill the above-mentioned gap among older people. METHOD A community-based cross-sectional study was conducted from April to June 2023. A total of 607 older people were included using the multistage sampling technique. An interview-administered questionnaire was used to assess depression using the Geriatric Depression Scale item 15 with a cut-off ≥5. For statistical analysis, the binary logistic regression model was employed. RESULTS The mean age of the study participants was 72.45 (SD ±9.08) years. The prevalence of depression was found to be 45%. Age 80 years and above, 70-79 years, widowed, retired, known chronic disease, and poor social support were associated factors with depression. CONCLUSION Compared to other studies conducted in different regions of Ethiopia, the prevalence of depression in this study was found to be high, at 45%. The results of this study may be taken as providing health professionals, health policymakers, and other pertinent stakeholders' early warning signs and guidance on how to take efficient control measures and conduct periodic monitoring among older people.
Collapse
Affiliation(s)
- Mihret Dejen Takele
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Jember Belay
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Kassa
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaw Marie Merawie
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fiseha Sefiwu Zinabu
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Cherkos
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemu Kassaw Kibret
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samuel Teferi Chanie
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
3
|
Mofina A, France C, Brown G, Sinha SK, Heurter D, Viveky N, MacLeod S, Jantzi M, Foster N, Hirdes J. Predictors of Pain and Mood Disturbances Among Older People in Custody Using an interRAI Assessment. JOURNAL OF CORRECTIONAL HEALTH CARE 2024. [PMID: 38946596 DOI: 10.1089/jchc.23.06.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The population of people in federal custody in Canada is aging. Those in custody report experiencing poorer health and high rates of chronic health conditions. Two health concerns that are disproportionately higher among those in custody are mood disorders and pain. This cross-sectional study examined health indicators associated with pain and depressive symptoms among older people (50 years and above) from multiple facilities and security levels in federal custody in Canada. Participants were assessed using the interRAI Emergency Department Contact Assessment, which captures key health indicators. Chi square and logistic regression analyses were conducted to describe the population and identify health indicators associated with mood- and pain-related outcomes, respectively. Of the 1,422 participants in this study, the majority (55%) experienced pain and at least 1 out of 5 experienced depressive symptoms. Health indicators associated with depressive symptoms and/or pain were functional measures, including mobility, managing medication(s), and dyspnea. Depressive symptoms and pain are highly prevalent among older adults in federal custody. The relationship between functional health, depressive symptoms, and pain highlights the importance of interprofessional health care and biopsychosocial intervention(s).
Collapse
Affiliation(s)
- Amanda Mofina
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Charlene France
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - Samir K Sinha
- Sinai Health System, Toronto, Canada
- University Health Network, Toronto, Canada
| | | | | | | | - Micaela Jantzi
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - John Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| |
Collapse
|
4
|
Reeb RN, Elvers G, Hunt CA, Turner TN, Ballas TN, Farmer CN, Gibbins K, Glendening ZS, Kinsey R, Latuch BD, Parker CN, Snow-Hill NL, Zicka JL, Bohardt D, Andrews R. Participatory community action research in homeless shelters: Outcomes for shelter residents and service-learning research assistants. J Prev Interv Community 2024; 52:173-197. [PMID: 38470612 DOI: 10.1080/10852352.2024.2317671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
The article reports empirical outcomes of an ongoing transdisciplinary participatory community action research project that implements behavioral activation in homeless shelters. The overall goal of this Project is twofold: (1) to improve psychosocial functioning of shelter residents and enhance their opportunities to overcome homelessness; and (2) to enhance civic development of service-learning students who assist in Project implementation. Two studies are reported, representing these goals. Study 1 found that residents of a men's shelter (n = 892), women's shelter (n = 433), and transitional housing (n = 40) perceived behavioral activation sessions as immediately beneficial (i.e., important, meaningful, worthy of repeating, and enjoyable), and over the course of shelter stay, they perceived behavioral activation as contributing to their hope, empowerment/self-sufficiency, quality of life, purpose/meaning in life, wellbeing, social support, shelter social climate, and relationships with staff. Quantitative findings are supported by qualitative data (comments by residents on forms). Study 2, which replicates and extends past research on civic-development in service-learning students, used a new quasi-experimental design to compare service-learning students (n = 41) in an interdisciplinary course on homelessness versus non-service-learning students (n = 16) in a psychology course. Service-learning students showed pre- to post-semester improvements in community service self-efficacy, decreases in stigmatizing attitudes, and increases in awareness of privilege and oppression, but students not engaged in service-learning did not show these civic-related changes. These quantitative results are supported by qualitative data (written reflections by students). Results and implications are discussed within the context of the concept of psychopolitical validity.
Collapse
Affiliation(s)
- Roger N Reeb
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Greg Elvers
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Charles A Hunt
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Tia N Turner
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Thomas N Ballas
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | | | - Katey Gibbins
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | | | - Rebecca Kinsey
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | | | | | | | | | | | | |
Collapse
|
5
|
Wuthrich VM, Dickson SJ, Pehlivan M, Chen JTH, Zagic D, Ghai I, Neelakandan A, Johnco C. Efficacy of low intensity interventions for geriatric depression and anxiety - A systematic review and meta-analysis. J Affect Disord 2024; 344:592-599. [PMID: 37858732 DOI: 10.1016/j.jad.2023.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This systematic review and meta-analysis examined the efficacy of low intensity psychological interventions for older adults (60+ years) with clinical anxiety and/or depressive disorders. METHOD Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression with an active or passive control condition (e.g., waitlist, treatment-as-usual or active control) in any setting. Low intensity psychological interventions (e.g., cognitive behaviour therapy [CBT]) targeted anxiety and/or depression as primary outcomes, were primarily self-help, and included support from trained practitioners/facilitators with <6 h total contact time (typically <30 min p/contact). RESULTS Seven studies consisting of 304 older adults (65-78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = -0.62) and large effect sizes for anxiety (Cohen's d = -0.84) at post-treatment. LIMITATIONS Results are limited by study design of included studies such that the efficacy of interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown. CONCLUSIONS There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. More research is needed to examine efficacy compared to active control conditions, and among those over 80 years.
Collapse
Affiliation(s)
- Viviana M Wuthrich
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia.
| | - Sophie J Dickson
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Melissa Pehlivan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Jessamine T-H Chen
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Dino Zagic
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Ishaan Ghai
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Aswathi Neelakandan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Carly Johnco
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| |
Collapse
|
6
|
Nshimyumuremyi E, Muziki JD, Harerimana E, Uwera T, Nshimiyimana A, Sebatukura SG, Mutabaruka J. Prevalence and Family Determinants of Geriatric Depression Among Elderly People in Elderly Support Groups in Rwanda. Psychol Res Behav Manag 2023; 16:1445-1455. [PMID: 37131955 PMCID: PMC10149077 DOI: 10.2147/prbm.s406386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Abstract
Background The 1994 Tutsi genocide in Rwanda significantly impacted family structure, with many people growing old alone and lacking social bonds and connections with family members. However, little is known about the contribution of the family environment to geriatric depression which was highlighted by WHO as a psychological problem with a 10% to 20% prevalence rate among the elderly worldwide. This study aims to investigate geriatric depression and associated family determinants among the elderly in Rwanda. Methods With a community-based cross-sectional study design, we assessed geriatric depression (GD), quality-of-life enjoyment and satisfaction (QLES), family support (FS), loneliness, neglect, and attitude toward grief in a convenience sample of 107 participants (M=72.32, SD=8.79) aged between 60 and 95 years who were recruited from three groups of elderly people supported by the NSINDAGIZA organization in Rwanda. SPSS (version 24) was used for statistical data analysis; differences across various sociodemographic variables were tested for significance by an independent t-test; the relationship between study variables was tested by Pearson correlation analysis; and multiple regression analysis was performed to model the contribution of independent variables to dependent variables. Results A total of 64.5% of the elderly scored above the threshold of the normal range of geriatric depression (SDS>49), with higher symptoms in women than in men. Multiple regression analysis indicated that family support and quality-of-life enjoyment and satisfaction were contributors to geriatric depression in the participants. Conclusion Geriatric depression was relatively common in our participants. It is associated with the quality of life and family support received. Hence, adequate family-based interventions are needed to improve the well-being of geriatric people in their respective families.
Collapse
Affiliation(s)
- Eric Nshimyumuremyi
- Department of Clinical Psychology, College of Medicine, and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean d’Amour Muziki
- Department of Clinical Psychology, College of Medicine, and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Tubarerere Mu Muryango (TMM), National Child Development Agency (NCD), Kigali, Rwanda
- Correspondence: Jean d’Amour Muziki, Department of Tubarerere Mu muryango (TMM), National Child Development Agency (NCD), A&P Building, 3rd Floor 18KG Ave Kigali, Kigali, Rwanda, Tel +250788887249, Email
| | - Eugene Harerimana
- Department of Clinical Psychology, College of Medicine, and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Thaoussi Uwera
- Department of Health Informatics, College of Medicine, and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Augustin Nshimiyimana
- Department of Clinical Psychology, College of Medicine, and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Siméon Gitimbwa Sebatukura
- Department of Clinical Psychology, College of Medicine, and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, College of Medicine, and Health Sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Corpas J, Gilbody S, McMillan D. Cognitive, behavioural or cognitive-behavioural self-help interventions for subclinical depression in older adults: A systematic review and meta-analysis. J Affect Disord 2022; 308:384-390. [PMID: 35460732 DOI: 10.1016/j.jad.2022.04.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Subclinical depression is a risk factor for the development of major depression in older adults. We aimed to determine the effectiveness of pure self-help or self-help with minimal support to reduce depressive symptoms and to prevent the onset of major depression in this population. METHODS This was a systematic review and meta-analysis of trials that used self-administrated cognitive, behavioural or cognitive-behavioural interventions for older adults with subclinical depression compared to control groups. Medline, Embase, PsycInfo and Cochrane databases were searched for relevant studies. RESULTS We analysed eight trials involving 1449 participants. A small but significant effect favouring the intervention was found at short-term [d = 0.33; 95% CI (Confidence Interval): 0.20-0.47] and at long-term (d = 0.22; 95% CI: 0.04-0.40) for depressive symptoms. None of the studies looked at the preventive effect of self-help interventions in reducing the probability of a subsequent diagnosis of major depression. LIMITATIONS The low number of studies meant that it was not possible to test for publication bias. The absence of pre-published protocols for many of the studies meant that there is a possibility of selective reporting bias for some of the primary studies. CONCLUSIONS There is some evidence that cognitive-behavioural self-help interventions may reduce depressive symptoms in older adults with subclinical depression. However, no study examined whether the intervention had a preventative effect in reducing the likelihood of a subsequent diagnosis of major depression.
Collapse
Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain.
| | - Simon Gilbody
- Hull York Medical School, United Kingdom; Department of Health Sciences, University of York, United Kingdom
| | - Dean McMillan
- Hull York Medical School, United Kingdom; Department of Health Sciences, University of York, United Kingdom
| |
Collapse
|
9
|
Zenebe Y, Akele B, W/Selassie M, Necho M. Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Ann Gen Psychiatry 2021; 20:55. [PMID: 34922595 PMCID: PMC8684627 DOI: 10.1186/s12991-021-00375-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It is also one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in elderly patients. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in half of the cases. Several studies showed different and inconsistent prevalence rates in the world. Hence, this study aimed to fill the above gap by producing an average prevalence of depression and associated factors in old age. OBJECTIVE This study aims to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression and its determinants among old age. METHOD A comprehensive search of PubMed, Scopus, Web of sciences, Google Scholar, and Psych-info from database inception to January 2020. Moreover, the reference list of selected articles was looked at manually to have further eligible articles. The random-effects model was employed during the analysis. Stata-11 was used to determine the average prevalence of depression among old age. A sub-group analysis and sensitivity analysis were also run. A graphical inspection of the funnel plots and Egger's publication bias plot test were checked for the occurrence of publication bias. RESULT A search of the electronic and manual system resulted in 1263 articles. Nevertheless, after the huge screening, 42 relevant studies were identified, including, for this meta-analysis, n = 57,486 elderly populations. The average expected prevalence of depression among old age was 31.74% (95% CI 27.90, 35.59). In the sub-group analysis, the pooled prevalence was higher among developing countries; 40.78% than developed countries; 17.05%), studies utilized Geriatrics Depression Scale-30(GDS-30); 40.60% than studies that used GMS; 18.85%, study instrument, and studies having a lower sample size (40.12%) than studies with the higher sample; 20.19%. CONCLUSION A high prevalence rate of depression among the old population in the world was unraveled. This study can be considered as an early warning and advised health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic care for the elderly population.
Collapse
Affiliation(s)
- Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Baye Akele
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulugeta W/Selassie
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
10
|
Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
Collapse
Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| |
Collapse
|
11
|
Ho MY. Boosting older adults' cognitive functioning and psychological Well-Being through Chinese tea therapy: A preliminary study. Aging Ment Health 2021; 25:2036-2041. [PMID: 33107326 DOI: 10.1080/13607863.2020.1839868] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effect of Chinese tea therapy on the enhancement of cognitive functioning and psychological well-being among older adults in Hong Kong. METHOD Seventeen healthy older adults recruited from two senior centers participated in a four-week Chinese tea therapy intervention. Pre-post measures on cognitive functioning and emotional well-being were used to examine the effect of the intervention on cognitive and emotional variables. RESULTS Results of the paired samples t-test revealed significant differences between the pre-test and post-test results for cognition and well-being. Specifically, the older adults showed enhanced cognitive functioning and improved emotional well-being after they received the Chinese tea therapy. CONCLUSION Chinese tea therapy is apparently an effective strategy to ensure healthy aging. In particular, this innovative and culturally relevant strategy may exert a protective effect against cognitive aging and decline and may boost emotional wellness of older adults in Asian cultures.
Collapse
Affiliation(s)
- Man Yee Ho
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| |
Collapse
|
12
|
Wang X, Zhou X, Yang H. Guided Self-Help Behavioral Activation Intervention for Geriatric Depression: Protocol for Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18259. [PMID: 32518060 PMCID: PMC7545326 DOI: 10.2196/18259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/18/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Aging is a social concern. The increased incidence of depression in older populations in China poses a challenge to the health care system. Older adults who are depressed often suffer from a lack of motivation. Behavioral activation treatment, an evidence-based guided self-help treatment, is effective in reducing anhedonia and amotivation in depression; however, the efficacy of guided self-help behavioral activation in older adults with depression is not yet known. Objective The aim of this study is to pilot a self-help guided intervention for the treatment of depression in older adults. Methods This study has been designed as a pilot randomized controlled trial with inpatients (n=60; to be randomly allocated 1:1) between the ages of 60 and 70 and who have major depressive disorder. Patients attending clinical psychological clinics at the Mental Health Center of Chongqing will be randomized to either receive guided self-help behavioral activation (intervention) or to be on a 6-week waiting list (control). Participants in the treatment group will receive 6 sessions of guided self-help behavioral activation delivered over the telephone. The waiting list control group will receive the intervention after a period of 6 weeks. Exclusion criteria will be individuals who are at significant risk of harming themselves or others, who have a primary mental health disorder other than depression, or who have an intellectual disability that would hamper their ability to participate in the intervention. Effects of the treatment will be observed using outcomes in 3 domains: (1) clinical outcomes (symptom severity, recovery rate), (2) process variables (patient satisfaction, attendance, dropout), and (3) economic outcomes (cost and resource use). We will also examine mediators of outcomes in terms of patient variables (behavioral activation or inhibition motivation). We hypothesize that guided self-help behavioral activation will have a beneficial effect. Results The study was approved by the research ethics committee of the Mental Health Center of Chongqing in November 2019. As of July 2020, recruitment had not yet begun. Data collection is expected to be completed by December 2020. Data analysis is expected to be completed by June 2021. Results will then be disseminated to patients, to the public, to clinicians, and to researchers through publications in journals and presentations at conferences. Conclusions This will be the first study in China to investigate guided self-help interventions for patients who are older adults and who are depressed, a group which is currently underrepresented in mental health research. The intervention is modular and adapted from an empirically supported behavioral activation treatment for depression. The generalizability and broad inclusion criteria are strengths. Trial Registration Chinese Clinical Trial Register ChiCTR1900026066; http://www.chictr.org.cn/showprojen.aspx?proj=43548 International Registered Report Identifier (IRRID) PRR1-10.2196/18259
Collapse
Affiliation(s)
- Xiaoxia Wang
- Department of Basic Psychology, College of Psychology, Army Medical University, Chongqing, China
| | - Xiaoyan Zhou
- Department of Clinical Psychology, Mental Health Center of Chongqing, Chongqing, China
| | - Hui Yang
- Department of Clinical Psychology, Mental Health Center of Chongqing, Chongqing, China
| |
Collapse
|
13
|
Uphoff E, Ekers D, Robertson L, Dawson S, Sanger E, South E, Samaan Z, Richards D, Meader N, Churchill R. Behavioural activation therapy for depression in adults. Cochrane Database Syst Rev 2020; 7:CD013305. [PMID: 32628293 PMCID: PMC7390059 DOI: 10.1002/14651858.cd013305.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Behavioural activation is a brief psychotherapeutic approach that seeks to change the way a person interacts with their environment. Behavioural activation is increasingly receiving attention as a potentially cost-effective intervention for depression, which may require less resources and may be easier to deliver and implement than other types of psychotherapy. OBJECTIVES To examine the effects of behavioural activation compared with other psychological therapies for depression in adults. To examine the effects of behavioural activation compared with medication for depression in adults. To examine the effects of behavioural activation compared with treatment as usual/waiting list/placebo no treatment for depression in adults. SEARCH METHODS We searched CCMD-CTR (all available years), CENTRAL (current issue), Ovid MEDLINE (1946 onwards), Ovid EMBASE (1980 onwards), and Ovid PsycINFO (1806 onwards) on the 17 January 2020 to identify randomised controlled trials (RCTs) of 'behavioural activation', or the main elements of behavioural activation for depression in participants with clinically diagnosed depression or subthreshold depression. We did not apply any restrictions on date, language or publication status to the searches. We searched international trials registries via the World Health Organization's trials portal (ICTRP) and ClinicalTrials.gov to identify unpublished or ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) of behavioural activation for the treatment of depression or symptoms of depression in adults aged 18 or over. We excluded RCTs conducted in inpatient settings and with trial participants selected because of a physical comorbidity. Studies were included regardless of reported outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles/abstracts and full-text manuscripts for inclusion. Data extraction and 'Risk of bias' assessments were also performed by two review authors in duplicate. Where necessary, we contacted study authors for more information. MAIN RESULTS Fifty-three studies with 5495 participants were included; 51 parallel group RCTs and two cluster-RCTs. We found moderate-certainty evidence that behavioural activation had greater short-term efficacy than treatment as usual (risk ratio (RR) 1.40, 95% confidence interval (CI) 1.10 to 1.78; 7 RCTs, 1533 participants), although this difference was no longer evident in sensitivity analyses using a worst-case or intention-to-treat scenario. Compared with waiting list, behavioural activation may be more effective, but there were fewer data in this comparison and evidence was of low certainty (RR 2.14, 95% CI 0.90 to 5.09; 1 RCT, 26 participants). No evidence on treatment efficacy was available for behavioural activation versus placebo and behavioural activation versus no treatment. We found moderate-certainty evidence suggesting no evidence of a difference in short-term treatment efficacy between behavioural activation and CBT (RR 0.99, 95% CI 0.92 to 1.07; 5 RCTs, 601 participants). Fewer data were available for other comparators. No evidence of a difference in short term-efficacy was found between behavioural activation and third-wave CBT (RR 1.10, 95% CI 0.91 to 1.33; 2 RCTs, 98 participants; low certainty), and psychodynamic therapy (RR 1.21, 95% CI 0.74 to 1.99; 1 RCT,60 participants; very low certainty). Behavioural activation was more effective than humanistic therapy (RR 1.84, 95% CI 1.15 to 2.95; 2 RCTs, 46 participants; low certainty) and medication (RR 1.77, 95% CI 1.14 to 2.76; 1 RCT; 141 participants; moderate certainty), but both of these results were based on a small number of trials and participants. No evidence on treatment efficacy was available for comparisons between behavioural activation versus interpersonal, cognitive analytic, and integrative therapies. There was moderate-certainty evidence that behavioural activation might have lower treatment acceptability (based on dropout rate) than treatment as usual in the short term, although the data did not confirm a difference and results lacked precision (RR 1.64, 95% CI 0.81 to 3.31; 14 RCTs, 2518 participants). Moderate-certainty evidence did not suggest any difference in short-term acceptability between behavioural activation and waiting list (RR 1.17, 95% CI 0.70 to 1.93; 8 RCTs. 359 participants), no treatment (RR 0.97, 95% CI 0.45 to 2.09; 3 RCTs, 187 participants), medication (RR 0.52, 95% CI 0.23 to 1.16; 2 RCTs, 243 participants), or placebo (RR 0.72, 95% CI 0.31 to 1.67; 1 RCT; 96 participants; low-certainty evidence). No evidence on treatment acceptability was available comparing behavioural activation versus psychodynamic therapy. Low-certainty evidence did not show a difference in short-term treatment acceptability (dropout rate) between behavioural activation and CBT (RR 1.03, 95% CI 0.85 to 1.25; 12 RCTs, 1195 participants), third-wave CBT (RR 0.84, 95% CI 0.33 to 2.10; 3 RCTs, 147 participants); humanistic therapy (RR 1.06, 95% CI 0.20 to 5.55; 2 RCTs, 96 participants) (very low certainty), and interpersonal, cognitive analytic, and integrative therapy (RR 0.84, 95% CI 0.32 to 2.20; 4 RCTs, 123 participants). Results from medium- and long-term primary outcomes, secondary outcomes, subgroup analyses, and sensitivity analyses are summarised in the text. AUTHORS' CONCLUSIONS This systematic review suggests that behavioural activation may be more effective than humanistic therapy, medication, and treatment as usual, and that it may be no less effective than CBT, psychodynamic therapy, or being placed on a waiting list. However, our confidence in these findings is limited due to concerns about the certainty of the evidence. We found no evidence of a difference in short-term treatment acceptability (based on dropouts) between behavioural activation and most comparison groups (CBT, humanistic therapy, waiting list, placebo, medication, no treatment or treatment as usual). Again, our confidence in all these findings is limited due to concerns about the certainty of the evidence. No data were available about the efficacy of behaioural activation compared with placebo, or about treatment acceptability comparing behavioural activation and psychodynamic therapy, interpersonal, cognitive analytic and integrative therapies. The evidence could be strengthened by better reporting and better quality RCTs of behavioural activation and by assessing working mechanisms of behavioural activation.
Collapse
Affiliation(s)
- Eleonora Uphoff
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Ekers
- Lanchester Road Hospital, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Dawson
- Cochrane Common Mental Disorders, University of York, York, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Sanger
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Zainab Samaan
- Psychiatry, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| |
Collapse
|
14
|
Samantaray NN, Pattanaik R, Srivastava K, Singh P. Psychological management of mental health concerns related to COVID-19: A review of guidelines and recommendations. Ind Psychiatry J 2020; 29:12-21. [PMID: 33776270 PMCID: PMC7989461 DOI: 10.4103/ipj.ipj_81_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/23/2020] [Accepted: 07/07/2020] [Indexed: 11/06/2022] Open
Abstract
Many publications have delineated strategies for mental health care to respond to psychological concerns and ramifications related to coronavirus disease 2019 (COVID-19). The current review aims to encapsulate existing guidelines and recommendations of psychological management for mental health care for the general population, health-care professionals, children, and elderly populations, applied to a pandemic in particular reference to COVID-19. The literature on psychological care of such repercussions of COVID-19 was retrieved via a search in PubMed and Google database. Of 91 retrieved initial articles, only 18 were selected for final analysis, which was divided into two categories: (a) guidelines by government/public health bodies (n = 11) and (b) publications in peer-reviewed journals (n = 7). The recommendations can be summed but not limited to psychoeducation from a reliable source, normalization of stress, behavioral activation, scheduling of activities with a bespoke blending of recreational and daily chores, supportive care, staying digitally connected, relaxation techniques, ensuring rest, rotating shifts and short breaks during working hours, curtailing media consumption, fostering community resilience, seeking and sharing support from colleagues/supervisors, avoidance of abusing psychoactive substances, online consultation of mental health professionals on need, and participatory communication in a developmentally appropriate way with children. In the absence of observational and controlled studies on psychological management during pandemic times, we recommend such research soon.
Collapse
Affiliation(s)
- Narendra Nath Samantaray
- Department of Clinical Psychology, Institute of Psychiatry and Human Behaviour, Bambolim, Goa, India
| | - Romalin Pattanaik
- De-addiction-Unit, MKCG Medical College and Hospital, Brahmapur, Ganjam, Odisha, India
| | - Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College, Wanowrie, Pune, Maharashtra, India
| | - Preeti Singh
- Department of Psychiatry, Pt. Jawaharlal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| |
Collapse
|
15
|
Burroughs H, Bartlam B, Bullock P, Lovell K, Ogollah R, Ray M, Bower P, Waheed W, Gilbody S, Kingstone T, Nicholls E, Chew-Graham CA. Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAnxiety and depression often coexist in older people. These disorders are often underdiagnosed and undertreated, and are associated with increased use of health and social care services, and raised mortality. Barriers to diagnosis include the reluctance of older people to present to their general practitioner (GP) with mood symptoms because of the stigma they perceive about mental health problems, and because the treatments offered are not acceptable to them.ObjectivesTo refine a community-based psychosocial intervention for older people with anxiety and/or depression so that it can be delivered by non-traditional providers such, as support workers (SWs), in the third sector. To determine whether or not SWs can be trained to deliver this intervention to older people with anxiety and/or depression. To test procedures and determine if it is feasible to recruit and randomise patients, and to conduct a process evaluation to provide essential information to inform a randomised trial.DesignThree phases, all informed by a patient and public involvement and engagement group. Qualitative work with older people and third-sector providers, plus a consensus group to refine the intervention, training, SW manuals and patient participant materials (phase 1). Recruitment and training of SWs (phase 2). Feasibility study to test recruitment procedures and assess fidelity of delivery of the intervention; and interviews with study participants, SWs and GPs to assess acceptability of the intervention and impact on routine care (phase 3).SettingNorth Staffordshire, in collaboration with Age UK North Staffordshire.InterventionA psychosocial intervention, comprising one-to-one contact between older people with anxiety and/or depression and a SW employed by Age UK North Staffordshire, based on the principles of behavioural activation (BA), with encouragement to participate in a group activity.ResultsInitial qualitative work contributed to refinement of the psychosocial intervention. Recruitment (and retention) of the SWs was possible; the training, support materials and manual were acceptable to them, and they delivered the intervention as intended. Recruitment of practices from which to recruit patients was possible, but the recruitment target (100 patients) was not achieved, with 38 older adults randomised. Retention at 4 months was 86%. The study was not powered to demonstrate differences in outcomes. Older people in the intervention arm found the sessions with SWs acceptable, although signposting to, and attending, groups was not valued by all participants. GPs recognised the need for additional care for older people with anxiety and depression, which they could not provide. Participation in the study did not have an impact on routine care, other than responding to the calls from the study team about risk of self-harm. GPs were not aware of the work done by SWs with patients.LimitationsTarget recruitment was not achieved.ConclusionsSupport workers recruited from Age UK employees can be recruited and trained to deliver an intervention, based on the principles of BA, to older people with anxiety and/or depression. The training and supervision model used in the study was acceptable to SWs, and the intervention was acceptable to older people.Future workFurther development of recruitment strategies is needed before this intervention can be tested in a fully powered randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN16318986.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 7, No. 25. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Heather Burroughs
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Mo Ray
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, York, UK
| | - Tom Kingstone
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Elaine Nicholls
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
- Collaboration for Leadership in Applied Health Research and Care West Midlands, Warwick, UK
| |
Collapse
|
16
|
Ning H, Harrison TC, Zhao Y, Hu H, Chen H, Liao L, Yu R, Wu S, Feng H. Correlates of Depressive Symptoms Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study in China. Res Gerontol Nurs 2019; 12:133-146. [DOI: 10.3928/19404921-20190306-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
|
17
|
Abstract
UNLABELLED ABSTRACTBackground:The number of elderly individuals living in China is increasing rapidly. The aim of this study was to examine the potential risk factors of geriatric depression in rural areas. METHODS A repeated cross-sectional study was conducted between January 2015 and October 2016 in rural China. Nine hundred forty-five elderly individuals were included in both investigations. A generalized estimating equation (GEE) was used to examine the relationships between geriatric depression and socio-demographics, the number of chronic diseases, ADL (Activity of Daily Living) disability, cognitive impairment, and anxiety. RESULTS Among the participants, the majority was female (61.4%) and illiterate (81.5%) and had a general economic status (63.0%) and more than two kinds of chronic diseases (62.9%). The bivariate analysis indicated that geriatric depression was associated with social support, education level, economic status, ADL disability, anxiety disorders, and cognitive impairment at both survey time points. The GEE results showed that poor economic status (OR = 8.294, p < 0.001), the presence of more than two chronic diseases (OR = 1.681, p = 0.048), ADL disability (OR = 2.184, p < 0.001), cognitive impairment (OR = 1.921, p < 0.001), and anxiety (OR = 5.434, p < 0.001) were risk factors for geriatric depression in rural China; better social support (OR = 0.924, 95% CI = 0.899-0.949, p < 0.001) was found to be a protective factor. CONCLUSIONS Geriatric depression in rural China was associated with several socio-demographic, physical, and mental factors. Targeted interventions are essential to improve the psychological health of aged individuals in rural China.
Collapse
|
18
|
Zapata AML, Beaudreau SA, O'Hara R, Bereknyei Merrell S, Bruce J, Garrison-Diehn C, Gould CE. Information-Seeking about Anxiety and Perceptions about Technology to Teach Coping Skills in Older Veterans. Clin Gerontol 2018; 41:346-356. [PMID: 28967837 DOI: 10.1080/07317115.2017.1359716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to learn where older veterans seek information about anxiety and coping. Due to increasing use of technology in health care, we also explored benefits and barriers of using technology to teach coping skills. METHODS Twenty veterans (mean age = 69.5 years, SD = 7.3) participated in semi-structured interviews in which we inquired about where they seek information about anxiety. We explored quantitative and qualitative differences for veterans with high versus low anxiety. In follow-up focus groups, we examined opinions about learning coping skills using technology. RESULTS Though veterans primarily named health care professionals as sources of information about anxiety, online searches and reading books were frequently mentioned. Reported benefits of using technology were convenience and standardized instruction of coping skills. Barriers included lack of interaction and frustration with technology usability. CONCLUSION Older veterans use multiple sources, heavily rely on interpersonal sources (e.g., professionals, friends), and employ varied search strategies regarding how to cope with anxiety. Using technology to teach coping skills was generally acceptable to older veterans. CLINICAL IMPLICATIONS Health care professionals could guide patients towards credible online and book sources. Providing instruction about using technology may help older adults use technology to learn coping skills.
Collapse
Affiliation(s)
- Aimee Marie L Zapata
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,b Pacific Graduate School of Psychology , Palo Alto University , Palo Alto , California , USA
| | - Sherry A Beaudreau
- c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,d Sierra Pacific Mental Illness Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Ruth O'Hara
- c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,d Sierra Pacific Mental Illness Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Sylvia Bereknyei Merrell
- e Department of Medicine, Division of General Medical Disciplines , Stanford University School of Medicine , Stanford , California , USA
| | - Janine Bruce
- f Department of Pediatrics, Division of General Pediatrics , Stanford University School of Medicine , Stanford , California , USA
| | - Christina Garrison-Diehn
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Christine E Gould
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| |
Collapse
|
19
|
Orgeta V, Brede J, Livingston G. Behavioural activation for depression in older people: systematic review and meta-analysis. Br J Psychiatry 2017; 211:274-279. [PMID: 28982660 DOI: 10.1192/bjp.bp.117.205021] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/27/2017] [Accepted: 07/03/2017] [Indexed: 11/23/2022]
Abstract
BackgroundBehavioural activation is an effective treatment for depression in the general adult population but it is unclear whether it is effective for older people.AimsTo systematically review randomised controlled trials (RCTs) of behavioural activation for depression in older people.MethodWe searched Medline, EMBASE, PsycINFO, CINAHL and online trial registers for RCTs of behavioural activation for depression in older people.ResultsEighteen trials were included in the meta-analyses. Behavioural activation reduced mean depression scores for older people living in the community as a stand-alone treatment: standardised mean difference (SMD) -0.72, 95% Cl -1.04 to -0.41. It was also effective as part of a multicomponent intervention (SMD -0.44, 95% CI -0.56 to -0.32).ConclusionsBehavioural activation significantly reduces depressive symptoms in older people in the community; however, given that most studies are small and with significant bias results should be interpreted with caution. Further high-quality trials of behavioural activation for this age group are needed.
Collapse
Affiliation(s)
- Vasiliki Orgeta
- Vasiliki Orgeta, PhD, Janina Brede, MSc, Gill Livingston, FRCPsych, MD, Division of Psychiatry, University College London, UK
| | - Janina Brede
- Vasiliki Orgeta, PhD, Janina Brede, MSc, Gill Livingston, FRCPsych, MD, Division of Psychiatry, University College London, UK
| | - Gill Livingston
- Vasiliki Orgeta, PhD, Janina Brede, MSc, Gill Livingston, FRCPsych, MD, Division of Psychiatry, University College London, UK
| |
Collapse
|
20
|
Alexopoulos GS, O’Neil R, Banerjee S, Raue PJ, Victoria LW, Bress JN, Pollari C, Arean PA. "Engage" therapy: Prediction of change of late-life major depression. J Affect Disord 2017; 221. [PMID: 28647669 PMCID: PMC5564217 DOI: 10.1016/j.jad.2017.06.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Engage grew out of the need for streamlined psychotherapies that can be accurately used by community therapists in late-life depression. Engage was based on the view that dysfunction of reward networks is the principal mechanism mediating depressive symptoms. Accordingly, Engage uses "reward exposure" (exposure to meaningful activities) and assumes that repeated activation of reward networks will normalize these systems. This study examined whether change in a behavioral activation scale, an index of reward system function, predicts change in depressive symptomatology. METHODS The participants (N = 48) were older adults with major depression treated with 9 weekly sessions of Engage and assessed 27 weeks after treatment. Depression was assessed with the 24-item Hamilton Depression Rating Scale (HAM-D) and behavioral activation with the four subscales of Behavioral Activation for Depression Scale (activation, avoidance/rumination, work impairment, social impairment) at baseline, 6 weeks (mid-treatment), 9 weeks (end of treatment), and 36 weeks. RESULTS Change only in the Activation subscale during successive periods of assessment predicted depression severity (HAM-D) at the end of each period (F1, 47 = 21.05, p<0.0001). An increase of one standard deviation in the Activation score resulted in a 2.04 (95% CI: 1.17-2.92) point decrease in HAM-D. For every one point increase in the Activation score, HAM-D was decreased by 0.22 points (95% CI: 0.12-0.31). LIMITATIONS No comparison group. Partial overlap of Activation Subscale with HAM-D, lack of detailed neurocognitive assessment and social support. CONCLUSION Change in behavioral activation predicts improvement of depressive symptoms and signs in depressed older adults treated with Engage.
Collapse
Affiliation(s)
- George S. Alexopoulos
- Weill-Cornell Institute of Geriatric Psychiatry,Corresponding author: George S. Alexopoulos, MD; Weill Cornell Institute of Geriatric Psychiatry; 21 Bloomingdale Road; White Plains, NY 10605. Phone: (914) 997-5767. Fax: (914) 997-5926.
| | - Robert O’Neil
- Weill Cornell Medical College, Department of Healthcare Policy and Research
| | - Samprit Banerjee
- Weill-Cornell Institute of Geriatric Psychiatry,Weill Cornell Medical College, Department of Healthcare Policy and Research
| | - Patrick J. Raue
- University of Washington, Department of Psychiatry and Behavioral Sciences
| | | | | | | | - Patricia A. Arean
- University of Washington, Department of Psychiatry and Behavioral Sciences
| |
Collapse
|
21
|
Holvast F, Massoudi B, Oude Voshaar RC, Verhaak PFM. Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis. PLoS One 2017; 12:e0184666. [PMID: 28938015 PMCID: PMC5609744 DOI: 10.1371/journal.pone.0184666] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background Late-life depression is most often treated in primary care, and it usually coincides with chronic somatic diseases. Given that antidepressants contribute to polypharmacy in these patients, and potentially to interactions with other drugs, non-pharmacological treatments are essential. In this systematic review and meta-analysis, we aimed to present an overview of the non-pharmacological treatments available in primary care for late-life depression. Method The databases of PubMed, PsychINFO, and the Cochrane Central Register of Controlled Trials were systematically searched in January 2017 with combinations of MeSH-terms and free text words for “general practice,” “older adults,” “depression,” and “non-pharmacological treatment”. All studies with empirical data concerning adults aged 60 years or older were included, and the results were stratified by primary care, and community setting. We narratively reviewed the results and performed a meta-analysis on cognitive behavioral therapy in the primary care setting. Results We included 11 studies conducted in primary care, which covered the following five treatment modalities: cognitive behavioral therapy, exercise, problem-solving therapy, behavioral activation, and bright-light therapy. Overall, the meta-analysis showed a small effect for cognitive behavioral therapy, with one study also showing that bright-light therapy was effective. Another 18 studies, which evaluated potential non-pharmacological interventions in the community suitable for implementation, indicated that bibliotherapy, life-review, problem-solving therapy, and cognitive behavioral therapy were effective at short-term follow-up. Discussion We conclude that the effects of several treatments are promising, but need to be replicated before they can be implemented more widely in primary care. Although more treatment modalities were effective in a community setting, more research is needed to investigate whether these treatments are also applicable in primary care. Trial registration PROSPERO CRD42016038442.
Collapse
Affiliation(s)
- Floor Holvast
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
- * E-mail:
| | - Btissame Massoudi
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Richard C. Oude Voshaar
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
| | - Peter F. M. Verhaak
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, the Netherlands
| |
Collapse
|
22
|
Jonsson U, Bertilsson G, Allard P, Gyllensvärd H, Söderlund A, Tham A, Andersson G. Psychological Treatment of Depression in People Aged 65 Years and Over: A Systematic Review of Efficacy, Safety, and Cost-Effectiveness. PLoS One 2016; 11:e0160859. [PMID: 27537217 PMCID: PMC4990289 DOI: 10.1371/journal.pone.0160859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/26/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives Depression in elderly people is a major public health concern. As response to antidepressants is often unsatisfactory in this age group, there is a need for evidence-based non-pharmacological treatment options. Our objectives were twofold: firstly, to synthesize published trials evaluating efficacy, safety and cost-effectiveness of psychological treatment of depression in the elderly and secondly, to assess the quality of evidence. Method The electronic databases PubMed, EMBASE, Cochrane Library, CINAL, Scopus, and PsycINFO were searched up to 23 May 2016 for randomized controlled trials (RCTs) of psychological treatment for depressive disorders or depressive symptoms in people aged 65 years and over. Two reviewers independently assessed relevant studies for risk of bias. Where appropriate, the results were synthesized in meta-analyses. The quality of the evidence was graded according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results Twenty-two relevant RCTs were identified, eight of which were excluded from the synthesis due to a high risk of bias. Of the remaining trials, six evaluated problem-solving therapy (PST), five evaluated other forms of cognitive behavioural therapy (CBT), and three evaluated life review/reminiscence therapy. In frail elderly with depressive symptoms, the evidence supported the efficacy of PST, with large but heterogeneous effect sizes compared with treatment as usual. The results for life-review/reminiscence therapy and CBT were also promising, but because of the limited number of trials the quality of evidence was rated as very low. Safety data were not reported in any included trial. The only identified cost-effectiveness study estimated an incremental cost per additional point reduction in Beck Depression Inventory II score for CBT compared with talking control and treatment as usual. Conclusion Psychological treatment is a feasible option for frail elderly with depressive symptoms. However, important questions about efficacy, generalizability, safety and cost-effectiveness remain.
Collapse
Affiliation(s)
- Ulf Jonsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroscience, Child and adolescent psychiatry, Uppsala University, Uppsala, Sweden
- National Board of Health and Welfare, Stockholm, Sweden
- * E-mail:
| | - Göran Bertilsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Per Allard
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Harald Gyllensvärd
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, Mälardalen, Våsterås, Sweden
| | - Anne Tham
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| |
Collapse
|
23
|
Ludvigsson M, Marcusson J, Wressle E, Milberg A. Markers of subsyndromal depression in very old persons. Int J Geriatr Psychiatry 2016; 31:619-28. [PMID: 26489528 DOI: 10.1002/gps.4369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/10/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate factors associated with subsyndromal depression (SSD) in very old persons, and to develop a model for prediction of SSD among very old persons. METHODS A cross-sectional, population-based study was undertaken on 85-year-old persons in Sweden. Data were collected from a postal questionnaire, assessments in the participants' homes and at reception visits. Depressiveness was screened with GDS-15 (Geriatric Depression Scale), and the results were classified into three outcome categories: non-depression (ND), SSD and syndromal depression. Data were analysed with binary logistic, ordinal logistic and linear regression. RESULTS With univariate logistic regression 20 factors associated with SSD were identified in very old persons, and the four hypothesized domains--sociodemographic factors, declining physical functioning, neuropsychiatric factors and existential factors--significantly related to SSD. The multivariate logistic model included seven independent factors that increase the likelihood of SSD instead of ND (lower self-perceived health, life not meaningful, problems with self-care, use of tranquilizing medication, no contact with neighbours, history of affective disorder and history of stroke). The ordinal logistic and the linear regression models resulted in seven partly different factors for predicting SSD and depressiveness, in the very old. CONCLUSIONS The identified markers may help clinicians with the detection, prevention and treatment of SSD in very old persons. The findings indicate the importance of a comprehensive functional approach to diagnosing and treating depressiveness in this population, and the findings might be interpreted as offering support for the coexistence of a dimensional and a categorical view on depressive disorders.
Collapse
Affiliation(s)
- Mikael Ludvigsson
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Psychiatry, County Council of Östergötland, Sweden
| | - Jan Marcusson
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Geriatrics, County Council of Östergötland, Sweden
| | - Ewa Wressle
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Geriatrics, County Council of Östergötland, Sweden
| | - Anna Milberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.,LAH/Unit of Palliative Care, County Council of Östergötland, and Palliative Education and Research Centre in the County of Östergötland,, Sweden
| |
Collapse
|
24
|
Huguet A, Rao S, McGrath PJ, Wozney L, Wheaton M, Conrod J, Rozario S. A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression. PLoS One 2016; 11:e0154248. [PMID: 27135410 PMCID: PMC4852920 DOI: 10.1371/journal.pone.0154248] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/11/2016] [Indexed: 12/21/2022] Open
Abstract
Depression is a common mental health condition for which many mobile apps aim to provide support. This review aims to identify self-help apps available exclusively for people with depression and evaluate those that offer cognitive behavioural therapy (CBT) or behavioural activation (BA). One hundred and seventeen apps have been identified after searching both the scientific literature and the commercial market. 10.26% (n = 12) of these apps identified through our search offer support that seems to be consistent with evidence-based principles of CBT or BA. Taking into account the non existence of effectiveness/efficacy studies, and the low level of adherence to the core ingredients of the CBT/BA models, the utility of these CBT/BA apps are questionable. The usability of reviewed apps is highly variable and they rarely are accompanied by explicit privacy or safety policies. Despite the growing public demand, there is a concerning lack of appropiate CBT or BA apps, especially from a clinical and legal point of view. The application of superior scientific, technological, and legal knowledge is needed to improve the development, testing, and accessibility of apps for people with depression.
Collapse
Affiliation(s)
- Anna Huguet
- Center for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjay Rao
- Annapolis Valley Health, Kentville, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick J. McGrath
- Center for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
- Departments of Pediatrics and Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Center for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Mike Wheaton
- Center for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jill Conrod
- Center for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sharlene Rozario
- Center for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
25
|
He G, Xie JF, Zhou JD, Zhong ZQ, Qin CX, Ding SQ. Depression in left-behind elderly in rural China: Prevalence and associated factors. Geriatr Gerontol Int 2015; 16:638-43. [PMID: 26017357 DOI: 10.1111/ggi.12518] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Guoping He
- Nursing School; Central South University; Changsha Hunan China
| | - Jian-fei Xie
- Nursing School; Central South University; Changsha Hunan China
- Department of Nursing; Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Jian-da Zhou
- Department of Science; Third Xiangya Hospital; Central South University; Changsha Hunan China
- The Business School; Central South University; Changsha Hunan China
| | - Zhu-qing Zhong
- Department of Nursing; Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Chun-xiang Qin
- Department of Nursing; Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Si-qing Ding
- Department of Nursing; Third Xiangya Hospital; Central South University; Changsha Hunan China
| |
Collapse
|
26
|
Hoge MA, Karel MJ, Zeiss AM, Alegria M, Moye J. Strengthening psychology's workforce for older adults: Implications of the Institute of Medicine's report to Congress. AMERICAN PSYCHOLOGIST 2015; 70:265-78. [PMID: 25844650 PMCID: PMC4860607 DOI: 10.1037/a0038927] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Professional psychology faces an urgent crisis, which the following facts paint in stark relief. Adults over age 65 will rise to 20% of the U.S. population over the next 15 years and already account for a third of the country's health care expenditures. Up to 8 million older adults experience mental health and substance use conditions in a given year, yet most psychologists receive no training in their assessment and treatment. No more than an estimated 4%, or 3,000, psychologists nationwide specialize in geropsychology; a ratio approaching 3,000 to 1. A small group of advocates within the profession have sounded the alarm and worked to strengthen geropsychology as a specialty, but this has had very limited impact on the actual supply of psychologists qualified to provide services to this population. In 2012, an Institute of Medicine (IOM) committee released a report on the crisis regarding the mental health and substance use workforce for older adults. Drawing on that report, a team composed of geropsychologists, along with psychologists who served on the IOM committee, identifies in this article priority areas for workforce development. The authors assess the progress of psychology in each of these areas and offer a set of recommendations for future efforts by this profession to develop its own workforce and to strengthen the ability of other caregivers to address the behavioral health needs of older adults. Strengthening its own workforce and responding to the needs of this population is imperative if psychology is to maintain its relevance as a health profession and meet its ethical obligations to an increasingly diverse society.
Collapse
Affiliation(s)
- Michael A Hoge
- Department of Psychiatry, Yale University School of Medicine
| | - Michele J Karel
- Mental Health Services, U.S. Department of Veteran Affairs, Central Office
| | - Antonette M Zeiss
- Mental Health Services, U.S. Department of Veteran Affairs, Central Office
| | - Margarita Alegria
- Center for Multicultural Mental Health Research, Cambridge Health Alliance
| | | |
Collapse
|
27
|
McGovern AR, Alexopoulos GS, Yuen GS, Morimoto SS, Gunning FM. Reward-related decision making in older adults: relationship to clinical presentation of depression. Int J Geriatr Psychiatry 2014; 29:1125-31. [PMID: 25306937 PMCID: PMC4353615 DOI: 10.1002/gps.4200] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Impairment in reward processes has been found in individuals with depression and in the aging population. The purpose of this study was twofold: (1) to use an affective neuroscience probe to identify abnormalities in reward-related decision making in late-life depression; and (2) to examine the relationship of reward-related decision making abnormalities in depressed, older adults to the clinical expression of apathy in depression. We hypothesized that relative to older, healthy subjects, depressed, older patients would exhibit impaired decision making and that apathetic, depressed patients would show greater impairment in decision making than non-apathetic, depressed patients. METHODS We used the Iowa Gambling Task to examine reward-related decision making in 60 non-demented, older patients with non-psychotic major depression and 36 older, psychiatrically healthy participants. Apathy was quantified using the Apathy Evaluation Scale. Of those with major depression, 18 individuals reported clinically significant apathy, whereas 42 participants did not have apathy. RESULTS Older adults with depression and healthy comparison participants did not differ in their performance on the Iowa Gambling Task. However, apathetic, depressed older adults adopted an advantageous strategy and selected cards from the conservative decks compared with non-apathetic, depressed older adults. Non-apathetic, depressed patients showed a failure to adopt a conservative strategy and persisted in making risky decisions throughout the task. CONCLUSIONS This study indicates that apathy in older, depressed adults is associated with a conservative response style on a behavioral probe of the systems involved in reward-related decision making. This conservative response style may be the result of reduced sensitivity to rewards in apathetic individuals.
Collapse
Affiliation(s)
- Amanda R. McGovern
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - George S. Alexopoulos
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Genevieve S. Yuen
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Sarah Shizuko Morimoto
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Faith M. Gunning
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| |
Collapse
|
28
|
Ludvigsson M, Milberg A, Marcusson J, Wressle E. Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People. THE GERONTOLOGIST 2014; 55:760-9. [PMID: 24398652 DOI: 10.1093/geront/gnt162] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/12/2013] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help. DESIGN AND METHODS Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata. RESULTS The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression. IMPLICATIONS The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.
Collapse
Affiliation(s)
- Mikael Ludvigsson
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden.
| | - Anna Milberg
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, LAH/Unit of Palliative Care, County Council of Östergötland, and Palliative Education and Research Centre in the County of Östergötland, Sweden
| | - Jan Marcusson
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden
| | - Ewa Wressle
- Division of Geriatric Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Geriatrics, County Council of Östergötland, Sweden
| |
Collapse
|
29
|
Alexopoulos GS, Arean P. A model for streamlining psychotherapy in the RDoC era: the example of 'Engage'. Mol Psychiatry 2014; 19:14-9. [PMID: 24280983 PMCID: PMC4337206 DOI: 10.1038/mp.2013.150] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/30/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
Abstract
A critical task for psychotherapy research is to create treatments that can be used by community clinicians. Streamlining of psychotherapies is a necessary first step for this purpose. We suggest that neurobiological knowledge has reached the point of providing biologically meaningful behavioral targets, thus guiding the development of effective, simplified psychotherapies. This view is supported by the Research Domain Criteria (RDoC) Project, which reflects the field's consensus and recognizes the readiness of neurobiology to guide research in treatment development. 'Engage' is an example of such a streamlined therapy. It targets behavioral domains of late-life depression grounded on RDoC constructs using efficacious behavioral strategies selected for their simplicity. 'Reward exposure' targeting the behavioral expression of positive valence systems' dysfunction is the principal therapeutic vehicle of 'Engage'. Its first three sessions consist of direct 'reward exposure', but the therapists search for barriers in three behavioral domains, that is, 'negativity bias' (negative valence), 'apathy' (arousal) and 'emotional dysregulation' (cognitive control), and add strategies targeting these domains when needed. The end result is a structured, stepped approach using neurobiological constructs as targets and as a guide to personalization. We argue that the 'reduction' process needed in order to arrive to simplified effective therapies can be achieved in three steps: (1) identify RDoC constructs driving the syndrome's psychopathology; (2) create a structured intervention utilizing behavioral and ecosystem modification techniques targeting behaviors related to these constructs; (3) examine whether the efficacy of the new intervention is mediated by change in behaviors related to the targeted RDoC constructs.
Collapse
|