Pains, joys, and secrets: nurse-led group therapy for older adults with depression

Longitudinal Outcomes of Resilience, Quality of Life, and Community Integration in Treatment-Resistant Depression: A Two-Group Matched Controlled Trial

BACKGROUND

Current evidence of nonpharmacological intervention for patients with treatment-resistant depression (TRD) is lacking. AIMS: To examine whether an 8-week nurse-led cognitive-behavioral based group intervention would enhance resilient coping and life quality among community-based patients with TRD.

METHOD

The participants were randomly sampled from a cohort of TRD recruited from two general teaching hospitals. The two groups were assessed with multiple outcome measures at baseline (T0); 8-week post-baseline (T1); and at 3, 6, and 9 months after T1 (T2-4). Psychoeducation was nested in the cognitive behavioral group intervention to facilitate discussion.

RESULTS

Of the 23 participants (mean age 56 years, 69.6% female) in the experimental group, higher resilient coping and lower mental distress levels at T1 as well as later improved quality of life and community integration at T2-4 were observed compared to the controls across COVID-19 (T3). Overall, the scores of resilience and community integration were higher throughout the four follow-up points of observations for the experimental group.

CONCLUSION

The findings indicated that an 8-week nurse-led cognitive-behavioral based group intervention may enhance the TRD patients' resilient coping and mental distress levels while providing the potentials for community reintegration after mental health psychoeducation engagement. It is imperative for the nurses caring for patients with TRD to extend from clinical-based intervention to community-based self-care approach, with the importance of short-term stress management and healthy lifestyle development highlighted during the community reintegration trajectory.

Introducing a group-based psychoeducation intervention for older people in an inpatient mental healthcare setting

This article reports on a service evaluation of a group-based psychoeducation programme for older people in an inpatient mental healthcare setting. It sought to explore how the programme was experienced by patients and staff, as well as its acceptability and the feasibility for implementation in the longer term. Via questionnaires, views were gathered from patients and staff. A focus group interview with staff facilitating the group sessions was also undertaken, and patient attendance records for sessions were collected and compared with demographic data relating to the two wards housed in the unit where the programme took place. The programme was generally viewed as a positive addition to care delivery by staff and patient respondents in offering an adjunct to pharmacological treatment, increasing familiarity with psychology staff, encouraging patients to develop a greater degree of mastery regarding their health and fostering mutual support among the patient community. The role of the ward environment in supporting access to group-based intervention is also considered.

Barriers and facilitators of engagement in psychological therapies among older adults with depression: A systematic review and thematic synthesis

WHAT IS KNOWN ON THE SUBJECT?: The utilization rate of psychological therapies is low in older adults with depression. The barriers and facilitators to engaging in psychological therapies experienced by older adults with depression are unclear. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Personal suitability for therapy engagement, practical abilities, personal therapy preferences, and familiarity with psychological therapies are associated with psychological therapy engagement. Psychological therapists can also impact psychological therapy engagement among older adults with depression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Proving the effectiveness and suitability of chosen psychological therapies is important for improving therapy engagement. Strategies for handling functional impairments among older adults with depression are necessary for engaging this population in psychological therapies. Although in-home psychological therapies are accessible, barriers to handling the technologies used for delivering the therapies should be addressed. More methods of accessing information about psychological therapies should be available to older adults in order for them to increase their knowledge on the topic. Psychological therapists should have positive attitudes and the competence to treat depression in older adults.

ABSTRACT

INTRODUCTION: Although psychological therapies are preferred by older adults, the utilization rate of these therapies is significantly low in older adults with depression. Understanding the barriers and facilitators to engaging in psychological therapies experienced by older adults is important for improving utilization rates.

AIM

This review aimed to explore the barriers and facilitators to engaging in psychological therapies experienced by older adults with depression.

METHODS

A systematic review of qualitative studies on psychological therapy engagement among older adults with depression. Relevant published studies and grey literature were searched. The Critical Appraisal Skills Programme tool was used to assess the quality of the included studies. The results of the included studies were synthesized using thematic synthesis.

RESULTS

Personal suitability for therapy engagement, practical abilities, personal therapy preferences and familiarity with psychological therapies was associated with therapy engagement. Therapists' competencies also affected therapy engagement.

DISCUSSION

Older adult's personal health status and requirements for psychological therapy should be considered.

IMPLICATIONS FOR PRACTICE

Mental health practitioners should consider whether specific psychological therapies are beneficial and acceptable for older adults. Improvements are needed in older adult's familiarity with psychological therapies and the ability of therapists to address the mental problems of older adults.

'Now My Eyes are Open': Latina women's experiences in long-term support groups for intimate partner violence survivors

One in four women has experienced intimate partner violence in their lifetimes. The effects of intimate partner violence on women's mental health may be long-term; possible conditions include post-traumatic stress disorder, depression, and anxiety. Latina women may be particularly vulnerable to long-term effects of intimate partner violence. The purpose of this study was to describe Latina women's experiences in long-term support groups for survivors of intimate partner violence. Forty-nine Latina women were interviewed about their experiences in a nurse-led long-term support group, with participation from 2 months to 9 years. The women ranged in age from 26 to 73 years and all but two interviews were in Spanish. Five themes emerged from the qualitative data: awakening, transformation, community, empowerment, and advocate. Women described their thoughts of still feeling the 'ugliness of the abuse', even years after it occurred with some women enduring abuse for as long as 32 years. The need for long-term support groups was evident as women described the value of the group for providing support and gaining an understanding that they are not alone, or their awakening to the idea that they can have a life without abuse. Long-term support groups give voice to Latina women who are survivors of intimate partner violence. By raising their awareness and sense of community, women survivors can be transformed and empowered to improve their lives and advocate for others who face similar struggles.

Nurse-led group cognitive behavioral therapy for major depressive disorder among adults in Japan: A preliminary single-group study

Objectives

The prevalence and burden of disease of depression necessitates effective and accessible treatment options worldwide. Since April 2016, Japanese national health insurance has covered nurse-administered cognitive behavioral therapy (CBT) for mood disorders. However, empirical support for nurse-led CBT for depression in Asian countries, especially in Japan, is still lacking. This preliminary study aimed to examine the feasibility and acceptability of nurse-led group CBT for Japanese patients with depression.

Methods

In this single-arm study, we evaluated the effects of a 6-week group CBT, led by trained nurses, on patients with major depression. The primary outcome was the Beck Depression Inventory-II (BDI-II). Assessments were conducted at the beginning and end of the intervention.

Results

Of 25 participants screened, 23 were eligible for the study (of these, three dropped out during the trial but were included in the analysis). Nurse-led group CBT led to significant improvements in the severity of depression (BDI-II, P < 0.001). The mean total BDI-II score improved from 23.1 (SD = 7.56) to 12.4 (SD = 8.57), and the pre-to post-effect size was large (Cohen's d = 1.33). After CBT, 45% of the participants were judged to be treatment responders, and 34% met the remission criteria.

Conclusions

Our preliminary findings indicate that 6 weeks of nurse-led group CBT produced a favorable treatment outcome for individuals with major depression in a Japanese clinical setting. The results of this study might encourage more Asian nurses to provide CBT as a part of their nursing practice. Further controlled trials that address the limitations of this study are required.

Leading an intervention for family caregivers-a part of nursing in palliative care

Professional leadership has been highlighted as an important part of successful intervention delivery. The aim of this study is to explore the narratives of nurses involved in leading a group intervention for family caregivers in palliative care. Nurses were interviewed about their experiences as group leaders in a psycho-educational group intervention, which was delivered at 10 specialised palliative home care settings, with the help of an intervention manual. Data were analysed with interpretive descriptive methodology. Three themes were identified in the analysis: embracing the leading role, developing qualities as a group leader, and professional and personal development. The results showed that the role as group leader initially was a challenge for the nurses, but that they gradually were able to develop the professional and personal skills that were required. The nurses believed that their profession was best suited to lead this kind of supportive intervention.

A systematic review of depression psychotherapies among Latinos

For decades, the literature has reported persistent treatment disparities among depressed Latinos. Fortunately, treatment development and evaluation in this underserved population has expanded in recent years. This review summarizes outcomes across 36 unique depression treatment studies that reported treatment outcomes for Latinos. Results indicated that there was significant variability in the quality of RCT and type/number of cultural adaptations. The review suggested that there might a relation between cultural adaptations with treatment outcomes; future studies are warranted to confirm this association. Cognitive Behavioral Therapy was the most evaluated treatment (CBT; n=18, 50% of all evaluations), followed by Problem Solving Therapy (PST; n=4), Interpersonal Therapy (IPT; n=4), and Behavioral Activation (BA; n=3). CBT seems to fare better when compared to usual care, but not when compared to a contact-time matched control condition or active treatment. There is growing support for PST and IPT as efficacious depression interventions among Latinos. IPT shows particularly positive results for perinatal depression. BA warrants additional examination in RCT. Although scarce, telephone and in-home counseling have shown efficacy in reducing depression and increasing retention. Promotora-assisted trials require formal assessment. Limitations and future directions of the depression psychotherapy research among Latinos are discussed.

Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults

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.

Efficacy and acceptability of group cognitive behavioral therapy for depression: a systematic review and meta-analysis

BACKGROUND

Despite treatment guidelines for depression placing group cognitive behavioral therapy (group CBT) between low- and high-intensity evidence-based psychological interventions, the validity of the placement remains unknown. We aimed to systematically review evidence for the efficacy and acceptability of group CBT in patients with depression compared to four intensity levels of psychosocial interventions.

METHODS

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science and hand-searched the references in identified publications. We selected randomized controlled trials comparing group CBT with four levels of interventions for adult patients with depression. Two authors independently assessed risk of bias.

RESULTS

From 7953 records, we identified 35 studies that compared group CBT to non-active (k=30), low-intensity (k=2), middle-intensity (k=8), and high-intensity (k=1) interventions. Group CBT had a superior efficacy (standardized mean difference [SMD]=-0.68) and a similar acceptability compared to non-active controls. Pooled results showed a small but non-significant excess of group CBT relative to middle-intensity interventions (SMD=-0.21).

LIMITATIONS

Over 60% of studies did not report enough information to judge selection and selective reporting bias.

CONCLUSIONS

These results suggest the need for high-quality trials of group CBT compared to low- and high-intensity interventions.