Late-life depression and functional disability: the role of goal-focused group psychotherapy

Hope therapy

Research over the past three decades has established that hope is related to positive outcomes. Hope therapy was originally developed to optimize successful goals pursuits by increasing hopeful thought. Here, we briefly review the current state of hope therapy research and offer directions for future investigations. We note that hope therapy has been adapted to be delivered in different formats, by providers from various professional backgrounds, and to participants presenting with a variety of chronic health conditions. We suggest there is a need to reach a consensus about what characterizes hope therapy. Further, we note the need for well-designed trials to test potential mechanisms of change. We believe that these future directions will result in a more efficacious hope therapy that can be widely disseminated.

Risk of incident dementia in late-life depression treated with antidepressants: A nationwide population cohort study

BACKGROUND

Antidepressants are frequently used to treat depression in patients with dementia. In addition, late-life depression is associated with the incidence of subsequent cognitive impairment or dementia. However, the association between exposure to antidepressants in late-life depression and the development of incident dementia remains understudied.

METHODS

Through a population-based retrospective cohort design, data were extracted from the Taiwan National Health Insurance Research Dataset of medical claims registered from 1998-2013. We collected data of individuals who had received a new diagnosis of depression between 2000 and 2007. We excluded those who received a diagnosis of depression and were given antidepressants before 2000 and those younger than 60 years. The primary outcome was the occurrence of incident dementia. The time from the prescription of antidepressants or the diagnosis of depression until the outcome or the end of 2013 was calculated as the time to event. A total of 563,918 cases were included and were divided into either antidepressant users or antidepressant nonusers. Cox proportional hazards models were used to calculate the hazard ratio and 95% confidence interval.

RESULTS

Exposure to antidepressants did not increase the risk of dementia in patients with late-life depression at either a low exposure dosage (hazard ratio: 1.06, 95% confidence interval: 0.91-1.23) or a high exposure dosage (hazard ratio: 1.07, 95% confidence interval: 0.95-1.20). To confirm the validity of our results, we performed a sensitivity analysis and subgroup analysis, and the post-hoc results were consistent with the main results.

CONCLUSION

Antidepressants did not increase the risk of incident dementia in patients with late-life depression.

Comparative clinical trials in psychotherapy: Have large effects been replicated?

AIMS

The purpose of this review is to examine the replication attempts of psychotherapy clinical trials for depression and anxiety. We focus specifically on replications of trials that exhibit large differences between psychotherapies. The replicability of these trials is especially important for meta-analysis, where the inclusion of false-positive trials can lead to erroneous conclusions about treatment efficacy.

METHODS

Standard replication criteria were developed to distinguish direct from conceptual replication methodologies. Next, an exhaustive literature search was conducted for published meta-analyses of psychotherapy comparisons. Trials that exhibited large effects (d > 0.8) were culled from these meta-analyses. For each trial, a cited replication was conducted to determine if the trial had been subsequently replicated by either 'direct' or 'conceptual' methods. Finally, a broader search was conducted to examine the extent of replication efforts in the psychotherapy literature overall.

RESULTS

In the meta-analytic search, a total of N = 10 meta-analyses met the inclusion criteria. From these meta-analyses, N = 12 distinct trials exhibited large effect sizes. The meta-analyses containing more than two large effect trials reported evidence for treatment superiority. A cited replication search yielded no direct replication attempts (N = 0) for the trials with large effects, and N = 4 conceptual replication attempts of average or above average quality. However, of these four attempts, only two partially corroborated the results from their original trial.

CONCLUSION

Meta-analytic reviews are influenced by trials with large effects, and it is not uncommon for these reviews to contain several such trials. Since we find no evidence that trials with such large effects are directly replicable, treatment superiority conclusions from these reviews are highly questionable. To enhance the quality of clinical science, the development of authoritative replication criteria for clinical trials is needed. Moreover, quality benchmarks should be considered before trials are included in a meta-analysis, or replications are attempted.

Infusing Positive Psychological Interventions Into Career Counseling for Diverse Populations

Using the strengths-based inclusive theory of work as a framework, this paper describes how positive psychological interventions (PPIs) can be infused within career and work counseling for diverse populations. Exemplar constructs targeted in the interventions include hope, strengths, adaptability, and empowerment. First, we discuss research related to hope, strengths, adaptability, and empowerment interventions, particularly studies related to career counseling. Second, we describe considerations and recommendations related to adapting PPIs for diverse groups. Finally, a case vignette is shared to demonstrate how PPIs and adapted PPIs might be infused when working with a client seeking career counseling.

Self-perceptions of aging mediate the longitudinal relationship of hopelessness and depressive symptoms

OBJECTIVES

The purpose of the current study was to examine the hypothesis that the prospective relationship between hopelessness and depressive symptoms is mediated by self-perceptions of aging.

METHODS

Data from 3 waves of the US Health and Retirement Study (2008, 2012, and 2014) were used (N = 4606; age M = 65.3, 55.5% female). In mediation analyses, hopelessness in 2008 was the independent variable, self-perceptions of aging in 2012 were the mediator, and depressive symptoms in 2014 were the outcome variable.

RESULTS

After controlling for covariates, hopelessness in 2008 was an independent predictor of self-perceptions of aging in 2012 (β = -.10, P < .001), and self-perceptions of aging in 2012 was an independent predictor of depressive symptoms in 2014 (β = -.41, P < .001). Hopelessness in 2008 showed both direct (β = .09, P < .001) and indirect (β = .03, P < .001) effects on depressive symptoms in 2014, indicating partial mediation by change in self-perceptions of aging.

CONCLUSIONS

As hypothesized, change in self-perceptions of aging partially mediated the relationship of hopelessness with depressive symptoms 6 years later. Findings are consistent with a conceptualization of hopelessness as broad negative expectations about the future that may contribute to negative self-perceptions of aging and subsequent changes in depressive symptoms. Reducing hopelessness, increasing hope, and improving self-perceptions of aging have potential to reduce and prevent depressive symptoms for older adults. Future research should examine the mechanisms of these interrelationships and other aging outcomes.

Longitudinal associations of hopelessness and loneliness in older adults: results from the US health and retirement study

BACKGROUND

Hopelessness and loneliness are potent risk factors for poor mental and physical health in later life, although the nature of their relationships with each other over time is not clear. The aim of the current study was to examine relationships between hopelessness and loneliness over an eight-year study period.

METHODS

Three waves of data from the US Health and Retirement Study (2006, 2010, 2014) were used to test a cross-lagged model of hopelessness and loneliness (N = 7,831), which allows for the simultaneous evaluation of the reciprocal associations of loneliness and hopelessness. Age in 2006, gender, years of education, number of medical conditions, and depressive symptoms were included as covariates.

RESULTS

The autoregressive effects of loneliness (B (SE) = 0.63 (0.02), p < 0.001) and hopelessness (B (SE) = 0.63 (0.02), p < 0.001) were substantive and significant across the three waves, pointing to the stability of both constructs over the eight-year study period. The lagged effect of loneliness on hopelessness was non-significant (B (SE) = 0.05 (0.03), p = 0.16), whereas the lagged effect of hopelessness on loneliness was significant (B (SE) = 0.01 (0.01), p = 0.03). These lagged effects were not significantly different from each other, however, χ2 (1) = 2.016, p = 0.156.

CONCLUSIONS

Participants who were more hopeless tended to become lonelier four years later, but lonelier participants did not become more hopeless four years later. Findings are tentative given the small magnitude and lack of difference between the cross-lagged effects. Future directions include replicating these findings in different samples and time frames, examining potential mechanisms of relationships between hopelessness and loneliness, and potential intervention strategies that might improve both conditions.

Effects of a strengths-based perspective support group among Taiwanese women who left a violent intimate partner relationship

AIMS AND OBJECTIVES

To examine the effects of an 8-week strengths-based perspective group intervention on hope, resilience and depression in Taiwanese women who left a violent intimate partner relationship.

BACKGROUND

Studies on interventions for abused women have primarily focused on psychological problems. However, the effect of group intervention on the psychological strengths of abused women is still unknown.

DESIGN

A two-group, quasi-experimental design using repeated measures was used in this study.

METHODS

Twenty-nine Taiwanese women who left violent intimate partner relationships were assigned to two groups and five participants did not complete the study. The experimental group (n = 8) underwent an 8-week strengths-based perspective group intervention developed by the investigators; the control group (n = 16) received no intervention. The effects of the intervention on the participants' hope, resilience and depression levels were evaluated as a pretest, post-test 1 (8th week) and post-test 2 (12th week) and were compared. The Chinese version of the State Hope Scale, the 25-item Resilience Scale, and the Taiwanese Depression Questionnaire were used in this study.

RESULTS

On the eighth and twelfth weeks after the strengths-based perspective group intervention, we found significantly lower scores on the depression scale in the experimental group. In the eighth week, participants in the experimental group had significantly lower scores on the pathway of hope subscales than those in the control group.

CONCLUSIONS

A strengths-based perspective support group intervention designed specifically for women who left a violent intimate partner relationship significantly reduced the participants' level of depressive symptoms and improved the pathway component of hope.

RELEVANCE TO CLINICAL PRACTICE

This research highlights the importance of nurses not only focused on problems but also on the psychological strengths in practice of abused women survivors.

Different interventions for post-ischaemic stroke depression in different time periods: a single-blind randomized controlled trial with stratification by time after stroke

OBJECTIVE

To determine the appropriate treatments for post-ischaemic stroke depression at different times after stroke.

DESIGN

A single-blind, randomized, controlled trial that compared three intervention groups, with subgroups stratified by time after stroke.

SETTING

Outpatient clinic.

SUBJECTS

Eligible patients were recruited at discharge ( n = 73) and three ( n = 67), six ( n = 65), and nine months ( n = 69) after discharge, and patients completed mood questionnaires.

INTERVENTIONS

Patients were randomly distributed into three groups: Group A received placebos and participated in general discussions; Group B, received citalopram and participated in general discussions; and Group C, received placebos and underwent cognitive behavioural therapy. All three groups participated in rehabilitation during three months of follow-up.

MAIN MEASURES

Outcome was assessed three months after baseline using the 17-item Hamilton Depression Scale (HAMD₁₇) and the Bech-Rafaelsen Melancholia Scale (MES). During treatment, the Udvalg for Kliniske Undersogelser side-effect scale was also administered.

RESULTS

When stratification was not considered, the scores of Group B on the Melancholia Scale were lower than those of Group A ( P = 0.02); when the four time-based subgroups were analysed, significant differences were observed between Groups A and B (P_MES = 0.02, P_HAMD17 = 0.02) in the group recruited six months after discharge and between Groups A and C (P_MES = 0.01) in the last time period nine months after discharge.

CONCLUSIONS

The effects of citalopram or cognitive behavioural therapy is similar to the effect of rehabilitation alone for early-onset post-ischaemic depression; rehabilitation and citalopram for delayed-onset post-ischaemic depression; and rehabilitation and cognitive behavioural therapy for late-onset post-ischaemic depression are more effective than rehabilitation alone.

Prevalence of depressive symptoms and its correlations with positive psychological variables among Chinese medical students: an exploratory cross-sectional study

BACKGROUND

Knowledge about the prevalence of depressive symptoms among Chinese medical students and its related factors is rather limited. Understanding the correlates of depressive symptoms and the roles that positive psychological variables play in depressive symptoms is of vital importance for future interventions. The main objectives of this study were to investigate the prevalence of depressive symptoms and the integrated effects of resilience, hope and optimism on depressive symptoms among Chinese medical students.

METHODS

This multi-center cross-sectional study was conducted in June 2014. The questionnaires that consisted of the Center for Epidemiologic Studies Depression Scale (CES-D), Wagnild and Young Resilience Scale-14 (RS-14), Adult Dispositional Hope Scale (ADHS), Life Orientation Test-Revised (LOT-R), and socio-demographic characteristics, were distributed to students at four medical colleges or universities in Liaoning province, China. A total of 2925 medical students became the final subjects. Hierarchical linear regression analyses were used to explore the integrated effects of resilience, hope and optimism on depressive symptoms.

RESULTS

The prevalence of depressive symptoms among Chinese medical students was 66.8 % (CES-D ≥ 16). Resilience, hope and optimism were all negatively correlated with depressive symptoms and they accounted for 26.1 % of the variance in depressive symptoms.

CONCLUSIONS

The high prevalence of depressive symptoms among Chinese medical students calls for special attention from all stakeholders, especially university authorities. Intervention strategies that focus on enhancing the positive psychological variables of resilience, hope and optimism can be integrated into depression prevention and treatment programs.

Hope as a Moderator of the Relationship Between Interpersonal Predictors of Suicide and Suicidal Thinking in African Americans

Suicide is currently the third leading cause of death of African Americans between the ages of 15 and 24 years. Possible risk factors of suicidal ideation for this population include the two interpersonal constructs of the Interpersonal Theory of Suicide, perceived burdensomeness and thwarted belongingness. Past research has demonstrated that hope is negatively associated with each of these two constructs of the Interpersonal Theory of Suicide and suicidal ideation. The aim of the current study was to investigate hope as a moderator between both thwarted belongingness and perceived burdensomeness and suicidal ideation in a sample of 107 African American college students. Results supported the hypotheses, as hope moderated the relationship between thwarted belongingness and suicidal ideation and perceived burdensomeness and suicidal ideation. This study suggests that African Americans who endorse high levels of hope are at a lower risk for suicidal thoughts when having perceptions of being a burden and not belonging. Clinical implications are discussed.

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.

In psoriasis, levels of hope and quality of life are linked

Psychological resources such as hope have been suggested to positively influence quality of life (QoL) in chronic disorders. Here, we determined hope levels of psoriasis vulgaris in-patients and analyzed their relation to QoL. A total of 60 (29 male) patients were assessed for their QoL with a generic tool (WHOQOL-BREF) and a skin disease-specific instrument, the Dermatology Life Quality Index (DLQI). Hope levels were determined by use of the Basic Hope Inventory. We found a positive correlation between hope and all domains of WHOQOL-BREF (physical: r = 0.446, p = 0.000; psychological r = 0.464, p = 0.000; social r = 0.302, p = 0.019; environmental r = 0.480, p = 0000; and global r = 0.501, p = 0.000) and a negative correlation with DLQI (r = -0.281, p = 0.030) indicating higher QoL in patients with high hope. Hope was not correlated with disease severity or duration. Hope may play a substantial role in preventing QoL impairment in psoriasis. Psychotherapeutic interventions aimed at strengthening hope could improve QoL in this condition.

Vascular depression: a new view of late-onset depression

We have suggested that cerebrovascular disease may predispose, precipitate, or perpetuate some late-life depressive syndromes. The mechanisms of "vascular depression" include disruption of cortico-striato-pallido-thalamo-cortical (CSPTC) pathways or their modulating systems. This view is supported by the presentation of vascular depression, which consists of depressive symptoms, cognitive abnormalities, as well as neuroimaging findings that may result from CSPTC impairment. Moreover, clinical and electrophysiological evidence of CSPTC impairment, an abnormality frequently found in patients with vascular depression, appears to be associated with poor response to antidepressant treatment and early relapse and recurrence. The vascular depression hypothesis provides the conceptual background for studies that may have clinical and theoretical impact. Agents influencing dopamine, acetylcholine, and opioid neurotransmitters may be studied in vascular depression, since these are essential neurotransmitters of the frontostriatal circuitry. Drugs used for prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The choice of antidepressants in vascular depression may depend on their effect on neurological recovery from ischemic lesions. Finally, identification of specific relationships between specific symptoms, cognitive deficits, and disability may lead to interventions that target the patients' deficits as well as their interactions with psychosocial factors known to contribute to depression. Research can clarify the pathways to vascular depression by focusing on the site of lesion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.

Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects

This systematic review evaluates the efficacy of psychosocial interventions for the acute treatment of late-life depression and identifies predictors of treatment outcomes and moderators of treatment effects. Problem-solving therapy, cognitive behavioral therapy, and treatment initiation and participation program have supportive evidence of efficacy, pending replication. Although the data on predictors of treatment outcomes and moderators of treatment effects are preliminary, it appears that baseline anxiety and stress level, personality disorders, endogenous depression, and reduced self-rated health predict worse depression outcomes. Future research may examine the moderating effects of baseline depression severity and identify other clinical or demographic moderators.

Is group psychotherapy effective in older adults with depression? A systematic review

OBJECTIVE

Earlier reviews and meta-analyses have consistently concluded that psychological treatment of depression is effective in older adults. We conducted a systematic review randomised controlled trials of group psychotherapy to present the best available evidence in relation to its effectiveness in older adults with depressive disorders.

METHODS

Electronic databases were searched to identify randomised controlled trials. Selected studies were quality assessed and data extracted by two reviewers.

RESULTS

Six trials met the inclusion criteria. The trials included in the review examined group interventions based on the cognitive behavioural therapy (CBT) model with active therapeutic interventions or waiting list controls. Group psychotherapy is an effective intervention in older adults with depression in comparison to waiting list controls, the overall effect size is very modest (MD = -3.92, 95%CI: -6.18, -1.67). The reported benefits of group intervention in comparison to other active interventions did not reach statistical significance. The benefits of group psychotherapy were maintained at follow-up. The quality of the studies varied and studies were heterogeneous.

CONCLUSIONS

Although quality of many studies was not optimal, the results of this meta analysis support the results of earlier meta analyses. Group cognitive behavioural therapy is effective in older adults with depression.

Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions

Less than half of older adults with depression achieve remission with antidepressant medications, and rates of remission are even poorer for those with comorbid conditions. Psychosocial interventions have been effective in treating geriatric depression, either alone or better yet, in combination with antidepressant medications. Traditional strategies for nonpharmacological treatment of late-life depression do not specifically address the co-occurring cognitive impairment and disability that is prevalent in this population. Newer therapies are recognizing the need to simultaneously direct treatment efforts in late-life depression towards the triad of depressive symptoms, cognitive dysfunction, and functional disability that is so often found in geriatric depression, and this comprehensive approach holds promise for improved treatment outcomes.

Hope, dispositional optimism and severity of depression following traumatic brain injury

PRIMARY OBJECTIVE

To investigate the extent in which two coping variables-hope and dispositional optimism-are related to depression severity amongst individuals who have sustained traumatic brain injury (TBI).

METHODS AND PROCEDURES

Sixty-five participants were administered the Beck Depression Inventory (BDI), the Adult Hope Scale (AHS), the Life Orientation Test-Revised (LOT-R) and a demographic and injury-related data questionnaire. In addition, relevant injury-related data was collected from the medical records.

MAIN OUTCOMES AND RESULTS

High levels of depression were experienced in the study sample, while hope and dispositional optimism were significantly lower in comparison to the general population. The correlation patterns indicate that both hope and dispositional optimism negatively correlated with participants' depression levels and that they showed significant positive correlations with each other. In the case of mild depression, the hope-Pathways sub-scale of the AHS was the only variable negatively correlated to it, while in moderate-to-severe depression all coping variables were negatively correlated to it. Regression analysis revealed that the AHS and LOT-R, but not the demographic and injury-related variables, predicted depression severity.

CONCLUSIONS

Clinical implications in referring persons with TBI with mild vs. severe depression to rehabilitation programmes are discussed.

Reminiscence and mental health: a review of recent progress in theory, research and interventions

This article explores recent progress in theory, research and practical applications of reminiscence. It first describes the evidence for reminiscence as a naturally occurring process, and discusses the different functions of reminiscence and their relationships with mental health and lifespan processes. Three basic types of reminiscence that relate to mental health are specified: conversations about autobiographical memories and the use of personal recollections to teach and inform others have social functions; positive functions for the self include the integration of memories into identity, recollections of past problem-solving behaviours, and the use of memories to prepare for one's own death; negative functions for the self are the use of past memories to reduce boredom, to revive bitterness, or to maintain intimacy with deceased persons. It is proposed that in interventions the three types are addressed differently: simple reminiscence stimulates social reminiscence and bonding and promotes positive feelings; life review uses the positive functions to enhance personal wellbeing; and life-review therapy seeks to reduce the negative uses and thereby alleviate symptoms of mental illness. Studies of the effectiveness of interventions have provided some evidence that interventions are effective in relation to their goals. The review closes with recommended directions for future reminiscence research.

Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD

AIM

This report considers the conceptual and methodological concerns confronting clinical investigators seeking to generate knowledge regarding the tolerability and benefits of pharmacotherapy in geriatric bipolar disorder (BD) patients.

METHOD

There is continuing need for evidence-based guidelines derived from randomized controlled trials that will enhance drug treatment of geriatric BD patients. Therefore, we present the complex conceptual and methodological choices encountered in designing a multisite clinical trial and the decisions reached by the investigators with the intention that study findings be pertinent to, and can facilitate, routine treatment decisions.

RESULTS

Guided by a literature review and input from peers, the tolerability and antimanic effects of lithium and valproate were judged to be the key mood stabilizers to investigate with regard to treating bipolar I disorder manic, mixed, and hypomanic states. The patient selection criteria are intended to generate a sample that not only experiences common treatment needs but also represents the variety of older patients seen in university-based clinical settings. The clinical protocol guides titration of lithium and valproate to target serum concentrations, with lower levels allowed when necessitated by limited tolerability. The protocol emphasizes initial monotherapy. However, augmentation with risperidone is permitted after three weeks when indicated by operational criteria.

CONCLUSIONS

A randomized, controlled trial that both investigates commonly prescribed mood stabilizers and maximizes patient participation can meaningfully address high-priority clinical concerns directly relevant to the routine pharmacologic treatment of geriatric BD patients.

Cognitive behavioural therapy and reminiscence techniques for the treatment of depression in the elderly: a systematic review

Psychotherapy, including cognitive behavioural therapy (CBT), reminiscence and general psychotherapy (GPT), is viewed as effective treatment for depression, but its efficacy in older people is not well defined. This systematic review included 14 randomized controlled trials that assessed the efficacy of psychotherapy for treating depression in elderly people (> or = 55 years). The results of this meta-analysis showed that, compared with placebo, psychotherapy was more effective in reducing depression scores (standardized mean difference -0.92; 95% confidence interval -1.21, -0.36). Subgroup analysis showed that CBT, reminiscence and GPT were all more effective than placebo; psychotherapy as an adjunct to antidepressant medication did not increase effectiveness. There was no significant difference between CBT and reminiscence in improving depression. A higher drop-out rate was observed in studies that did not include psychotherapy versus those that did, although this difference was not statistically significant. Thus, various general formats of psychotherapy are effective for treating depression in older people, although psychotherapy does not significantly increase the effectiveness of anti-depressant medication.

Psychotherapeutic treatments for older depressed people

BACKGROUND

Despite a number of reviews advocating psychotherapy for the treatment of depression, there is relatively little evidence based on randomised controlled trials that specifically examines its efficacy in older people.

OBJECTIVES

To examine the efficacy of psychotherapeutic treatments for depression in older people.

SEARCH STRATEGY

CCDANCTR-Studies and CCDANCTR-References were searched on 11/9/2006. The International Journal of Geriatric Psychiatry and Irish Journal of Psychiatry were handsearched. Reference lists of previous published systematic reviews, included/excluded trial articles and bibliographies were scrutinised. Experts in the field were contacted..

SELECTION CRITERIA

All randomised controlled trials that included older adults diagnosed as suffering from depression (ICD or DSM criteria) were included. All types of psychotherapeutic treatments were included, categorised into cognitive behavioural therapies (CBT), psychodynamic therapy, interpersonal therapy and supportive therapies.

DATA COLLECTION AND ANALYSIS

Meta-analysis was performed, using odds ratios for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95% confidence intervals. Primary outcomes were a reduction in severity of depression, usually measured by clinician rated rating scales. Secondary outcomes, including dropout and life satisfaction, were also analysed.

MAIN RESULTS

The search identified nine trials of cognitive behavioural and psychodynamic therapy approaches, together with a small group of 'active control' interventions. No trials relating to other psychotherapeutic approaches and techniques were found. A total of seven trials provided sufficient data for inclusion in the comparison between CBT and controls. No trials compared psychodynamic psychotherapy with controls. Based on five trials (153 participants), cognitive behavioural therapy was more effective than waiting list controls (WMD -9.85, 95% CI -11.97 to -7.73). Only three small trials compared psychodynamic therapy with CBT, with no significant difference in treatment effect indicated between the two types of psychotherapeutic treatment. Based on three trials with usable data, CBT was superior to active control interventions when using the Hamilton Depression Rating Scale (WMD -5.69, 95% CI -11.04 to -0.35), but equivalent when using the Geriatric Depression Scale (WMD -2.00, 95% CI -5.31 to 1.32).

AUTHORS' CONCLUSIONS

Only a small number of studies and patients were included in the meta-analysis. If taken on their own merit, the findings do not provide strong support for psychotherapeutic treatments in the management of depression in older people. However, the findings do reflect those of a larger meta-analysis that included patients with broader age ranges, suggesting that CBT may be of potential benefit.

Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials

BACKGROUND

Older meta-analyses of the effects of psychological treatments for depression in older adults have found that these treatments have large effects. However, these earlier meta-analyses also included non-randomized studies, and did not include newer high-quality randomized controlled trials.

METHODS

We conducted a meta-analysis of randomized studies on psychological treatments for depression in older adults.

RESULTS

Twenty-five studies were included, of which 17 compared a psychological intervention to a control condition (mainly waiting list and care-as-usual control groups). The quality of the included studies varied. Psychological treatments have moderate to large effects on depression in older adults (standardized mean effect size d = 0.72). Heterogeneity was very low. No differences were found between individual, group or bibliotherapy format, or between cognitive behavioral therapy and other types of psychological treatment. The effects were comparable in studies where depression was defined according to diagnostic criteria, and those in which depression was measured with self-rating questionnaires.

CONCLUSION

Although the quality of many studies was not optimal, the results of this meta-analysis support the results of earlier meta-analyses, which also included non-randomized studies. Psychological treatments are effective in the treatment of depression in older adults.

Hope in Cognitive Psychotherapies: On Working With Client Strengths

The field of psychology, which is traditionally rooted in the study and treatment of psychological disorders and pathology, recently has begun to embrace an examination of individual, as well as societal, strengths and virtues. This subspecialty within psychology, known as positive psychology, can be defined as the attempt to understand the characteristics and processes that contribute to optimal functioning, flourishing, and resiliency. The purpose of the present article is to draw a link between traditional psychology and positive psychology using the example of the positive psychological construct of hope. Specifically, we explore the ways in which hope theory can be incorporated into traditional forms of cognitive therapy for symptom reduction and elimination. First, the theory of hope (Snyder, 1994) is introduced and the concept of hopeful thought is defined. Next, we explore the distinction between Snyder’s definition of hope and Beck’s definition of hopelessness (Beck, Weissman, Lester, & Trexler, 1974). Finally, we present possible strategies for utilizing hope concepts in cognitive therapies. Studying individuals with high levels of hope has resulted in a wealth of information about the ways these individuals overcome obstacles and find multiple ways to the goals that they have set for themselves. Integrating these lessons into empirically based treatments for symptom reduction is likely to result in a synergy that utilizes the most sound aspects of both traditional psychology and positive psychology.

Social anxiety and posttraumatic stress in combat veterans: Relations to well-being and character strengths

There are few studies examining the relationship between psychopathology and positive experiences and traits. Although initial studies suggest persons with posttraumatic stress disorder (PTSD) are at increased risk for excessive social anxiety, there have been no studies to date evaluating how these conditions might interact to affect positive experiences and traits. Using self-report scales, informant ratings, and experience-sampling methodologies, we examined the association of social anxiety with well-being and character strengths in veterans with and without PTSD. Controlling for PTSD and trait negative affect, social anxiety was negatively related to global ratings of well-being and character strengths. Social anxiety also accounted for incremental variance in day-to-day well-being (i.e., daily affect balance, percentage of pleasant days, positive social activity, self-esteem, gratitude) over a 14-day assessment period. Although veterans with PTSD reported lower levels of global and daily well-being and character strengths than veterans without PTSD, a diagnosis of PTSD failed to exhibit unique relationships with these constructs. Building on a growing body of work, these data suggest that social anxiety is uniquely associated with disturbances in positive experiences, events, and traits. Our findings support the value of directly addressing social anxiety in the study and treatment of PTSD.

Group therapy for depressed elderly women

We describe and evaluate a group therapy program targeting depression among elderly residents (N=303) of subsidized high-rise apartments in Nashville, TN. This eclectic program was comprised of 12 sessions (a total of 24 hours) that included modules on exercise and preventive health behaviors, cognitive and re-motivation therapy, reminiscence and grief therapy, and social skills development. Our multivariate regression analyses of pre-post measures using the Geriatric Depression Scale (GDS) showed that the effects of the group therapy varied by race, age, and level of initial depression among the participants. The program was effective in reducing depression, but only among Caucasian women who reported at least moderate depression prior to the program, and it yielded greater benefits for women between 55 and 75 years of age.

Current status of psychotherapy for mental disorders in the elderly

Research on psychotherapy for older adults with psychiatric disorders has demonstrated its effectiveness, although the majority of research has been conducted on major depression. Recent advances in extending this research to additional diagnostic categories and treatment settings are reviewed. Psychotherapy appears promising in the treatment of minor depression, dysthymia, anxiety disorders, depression with comorbid personality disorders, depression with comorbid cognitive impairment, and as an adjunctive treatment in psychotic disorders. Psychotherapy also has been successfully transported to the primary care setting, and shows potential in long-term care and in-home settings. Many of these studies are preliminary, however; additional research is needed with larger, more diverse samples across a variety of psychiatric diagnoses and treatment settings.

Effects of reminiscence and life review on late-life depression: a meta-analysis

AIM

To assess the effectiveness of reminiscence and life review on late-life depression across different target groups and treatment modalities.

METHOD

Twenty controlled outcome studies were retrieved from Psychlit, Medline and Dissertation Abstracts. For each study a standardised effect size, d, was calculated and a random-effects meta-analysis was conducted.

RESULTS

An overall effect size of 0.84 (95% Confidence Intervals (CI)=0.31-1.37) was found, indicating a statistically and clinically significant effect of reminiscence and life review on depressive symptomatology in elderly people. This effect is comparable to the effects commonly found for pharmacotherapy and psychological treatments. The effect was larger in subjects with elevated depressive symptomatology (d=1.23) as compared to other subjects (d=0.37). Other characteristics of the subjects or interventions were not found to be related to increased or decreased effect sizes.

DISCUSSION

Reminiscence and life review are potentially effective treatments for depressive symptoms in the elderly and may thus offer a valuable alternative to psychotherapy or pharmacotherapy. Especially in non-institutionalised elderly people-who often have untreated depression-it may prove to be an effective, safe and acceptable form of treatment. Randomized trials with sufficient statistical power are necessary to confirm the results of this study.

Coping with terminal illness: the role of hopeful thinking

Using Snyder's theory of hope, the role of hope in the process of dying from a terminal illness is discussed. In this theory, hope is defined as the perceived capability to produce workable routes to desired goals (pathways thinking) and the requisite motivation to use those routes (agency thinking). Strategies by which individuals can maintain and even increase hope during the dying process are described, along with interventions to maintain patients' hope. Directions for future research are suggested.

Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression

Over the past 20 years, numerous studies have investigated the efficacy of psychotherapy for treating late life depression and, to a lesser degree, the efficacy of psychotherapy combined with antidepressant medication. Of the intervention studies, cognitive-behavioral therapy and interpersonal psychotherapy combined with antidepressant medication have the largest base of evidence in support of their efficacy for late life depression. To a lesser degree, there is support for stand-alone interpersonal psychotherapy, brief dynamic therapy, and life review treatments. The purpose of this review is to present data on the acute and long-term effects of cognitive-behavioral therapy, interpersonal psychotherapy, brief dynamic therapy, and combined antidepressant medication and psychotherapy to discuss the generalizability of these interventions, and to discuss future research directions and the need for increased opportunities for this area of research.

Revisão sobre a eficácia de psicoterapia vs. farmacoterapia no tratamento de depressão em idosos

INTRODUÇÃO: Depressão é uma das doenças mentais mais prevalentes entre pessoas idosas. Embora os tratamentos farmacológicos já estejam validados, a recorrência de depressão é comum. Este artigo revisa ensaios clínicos que examinaram a eficácia da psicoterapia versus os tratamentos farmacológicos, sozinhos ou combinados, para pessoas idosas com depressão. MÉTODOS: Foi realizada busca na internet, em dois bancos de dados (Medline e PsychINFO), por ensaios clínicos randomizados e controlados publicados entre 1984 e 2001 que examinaram a eficácia de psicoterapias versus farmacoterapia para depressão em indivíduos com 60 anos ou mais, com diagnóstico de distimia, depressão menor ou maior. RESULTADOS: Foram incluídos quatro estudos. Três compararam a eficácia da psicoterapia versus a farmacoterapia durante a fase aguda e de continuação do tratamento para depressão, e um examinou a eficácia desses tratamentos durante a fase de manutenção. Tratamentos com psicoterapia (sozinha ou combinada com medicação) foram superiores à farmacoterapia em três estudos com sujeitos com depressão maior. Psicoterapia não foi superior a placebo ou antidepressivos em um estudo com sujeitos com distimia ou depressão menor. CONCLUSÃO: As evidências empíricas sobre a eficácia da psicoterapia versus a farmacoterapia para pacientes idosos com depressão são escassas e não conclusivas, sugerindo a necessidade de novos ensaios clínicos que investiguem a eficácia da psicoterapia para o tratamento de depressão em idosos.