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The mechanisms underlying the negative effect of depression on life satisfaction among the elderly: the roles of ostracism and economic income. Int Psychogeriatr 2022; 34:715-724. [PMID: 34593081 DOI: 10.1017/s1041610221001162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Depression is prevalent among older persons, which seriously threatens their life satisfaction. This study aimed to explore the internal mechanisms by which depression influences life satisfaction among the elderly, as well as the mediating and moderating effects of ostracism and economic income, respectively, in a sample of rural older adults across China. DESIGN This was a cross-sectional survey conducted as part of the project "Thousands of People and Hundreds of Villages (2019)." SETTING Participants were rural older adults from 31 provincial-level administrative units across China. PARTICIPANTS The sample composed of 1,754 participants aged 60 years and over. MEASUREMENTS Depression was assessed with the depression subscale of the Depression Anxiety Stress Scales, life satisfaction with the Satisfaction with Life Scale, ostracism with the Ostracism Experience Scale (OES), and economic income and other control variables with related demographic scales. Moderation and mediation analyses were performed using the regression-based approach as conducted by Hayes (). RESULTS Depression negatively predicted life satisfaction among the elderly. Ostracism played a partially mediating role between depression and life satisfaction. Economic income moderated the effect of depression and ostracism on life satisfaction: High economic income weakened the negative effect of depression on life satisfaction and enhanced the negative effect of ostracism on life satisfaction. CONCLUSION Improving depressed elderly people's interpersonal relationships and financial support could improve their life satisfaction.
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Bentham C, Eaves L. The Impact of Cognitive-Behavioral Interventions on Sleep Disturbance in Depressed and Anxious Community-dwelling Older Adults: A Systematic Review. Behav Sleep Med 2022; 20:477-499. [PMID: 34120539 DOI: 10.1080/15402002.2021.1933488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Depression and anxiety are prevalent mental health conditions in older adulthood. Despite sleep disturbance being a common comorbidity in late-life depression and anxiety, it is often discounted as a target for treatment. The current review aims to establish whether cognitive-behavioral therapy (CBT) is effective in treating concomitant sleep disturbance in depressed and anxious older adults and to review evidence supporting whether CBT interventions targeting anxiety and depression, or concurrent sleep disturbance, have the greatest effectiveness in this client group. METHOD A systematic database search was conducted to identify primary research papers evaluating the effectiveness of CBT interventions, recruiting older adults with symptoms of depression and/or anxiety, and employing a validated measure of sleep disturbance. The identified papers were included in a narrative synthesis of the literature. RESULTS Eleven identified studies consistently support reductions in sleep disturbance in elderly participants with depression and anxiety in response to CBT. Most CBT interventions in the review included techniques specifically targeting sleep, and only one study directly compared CBT for insomnia (CBT-I) with a CBT-I intervention also targeting depressive symptoms, limiting the ability of the review to comment on whether interventions targeting sleep disturbance or mental health symptoms have superior effectiveness. CONCLUSION The extant research indicates that CBT interventions are effective in ameliorating sleep disturbance in late-life depression and anxiety. Future high-quality research is required to substantiate this finding and to compare the effectiveness of CBT-I and CBT for depression and anxiety in this group to inform clinical practice.
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Affiliation(s)
| | - Lucy Eaves
- Department of Psychological Services, Sheffield Teaching Hospitals, UK
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3
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Rada C. Factors Associated with Depression in Middle-Aged and Elderly People in Romania. PSICHOLOGIJA 2020. [DOI: 10.15388/psichol.2020.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objectives of this study were the determination of the prevalence of self-reported depressive symptoms by the Geriatric Depression Scale and the influences of variable income, physical activity, socialization and sexual activity. A total of 601 patients aged 55–93 years with a mean age of 67.32 years and a median age of 67 years participated in this study between 2016 and 2017. Non-cooperative people and individuals with strong auditory or visual sensory deficits, severe cognitive deficits, or disorders accompanied by psychotic elements with serious somatic pathology were excluded from the interviews. Employing the SPSS GENLIN procedure, an ordinal logistic model was used. Over ½ of the respondents are within the categories of moderate and severe depression, almost half of the respondents feel that their family incomes are not enough or make it hard to meet their needs, approximately 10% think they are sedentary, over ½ participate in no sexual activity, and over ¼ do not frequently respond with pleasure to partner-initiated sexual relationships. Those who were in the higher depression category perceived their income to be extremely low (p = .001), perceived themselves as sedentary (p < .001), infrequently met with friends or neighbours in their leisure time (p = .002), and had lower sexual interest (p < .001). Middle-aged adults and older adults should learn about the health benefits of physical activity, socialization and sexual activity. Social policies must take into account this low-income segment. Poverty itself can be a contributor to depressive states, and additionally, due to their low incomes, elderly people are at risk of benefiting less from pharmacotherapy and psychotherapy.
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Bazrafshan MR, Jokar M, Shokrpour N, Delam H. The effect of lavender herbal tea on the anxiety and depression of the elderly: A randomized clinical trial. Complement Ther Med 2020; 50:102393. [DOI: 10.1016/j.ctim.2020.102393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/19/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022] Open
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Stanley MA, Wilson NL, Shrestha S, Amspoker AB, Wagener P, Bavineau J, Turner M, Fletcher TL, Freshour J, Kraus-Schuman C, Kunik ME. Community-Based Outreach and Treatment for Underserved Older Adults With Clinically Significant Worry: A Randomized Controlled Trial. Am J Geriatr Psychiatry 2018; 26:1147-1162. [PMID: 30224269 DOI: 10.1016/j.jagp.2018.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/05/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether Calmer Life (CL) improved worry, generalized anxiety disorder-related (GAD-related) symptoms, anxiety, depression, sleep, trauma-related symptoms, functional status, and quality of life better than Enhanced Community Care with Resource Counseling (ECC-RC) at 6 months and 9 months. METHODS A randomized, controlled, comparative-effectiveness study involving underserved, low-income, mostly minority neighborhoods in Houston, Texas, looked at individuals ≥50 with significant worry and interest in psychosocial treatment. Interventions were CL, cognitive behavioral therapy with resource counseling, facilitation of communication with primary care providers about worry/anxiety, integration of religion/spirituality, person-centered skill content and delivery and nontraditional community providers, ECC-RC, and enhanced standard community-based information/ resource counseling addressing basic unmet and mental health needs. Primary outcomes were worry and GAD-related symptom severity. Secondary outcomes were anxiety, depression, sleep difficulties, trauma-related symptoms, functional status, quality of life, service use and satisfaction. RESULTS Similar, moderate improvements followed CL and ECC-RC on worry, GAD-related symptoms, anxiety, depression, sleep, trauma-related symptoms, and mental health quality of life at 6 and 9 months, but with symptoms at both times and higher satisfaction with CL at both. Fewer ECC-RC participants reported a hospital admission in the prior 3 months than those in CL at 6 and 9 months; at 9 months, fewer reported a visit with a provider in the previous 3 months. CONCLUSION Both interventions showed similar improvements at 6 and 9 months, but symptoms remained that might require care. Either intervention or a combination may be useful for low-income older adults with identified worry/anxiety.
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Affiliation(s)
- Melinda A Stanley
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston.
| | - Nancy L Wilson
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Srijana Shrestha
- St. Thomas University (SS), Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Amber B Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Paula Wagener
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | | | | | - Terri L Fletcher
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston
| | - Jessica Freshour
- Michael E. DeBakey VA Medical Center (JF, CKS), Houston, TX; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Cynthia Kraus-Schuman
- Michael E. DeBakey VA Medical Center (JF, CKS), Houston, TX; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Mark E Kunik
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston
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Chang KJ, Hong CH, Roh HW, Lee KS, Lee EH, Kim J, Lim HK, Son SJ. A 12-Week Multi-Domain Lifestyle Modification to Reduce Depressive Symptoms in Older Adults: A Preliminary Report. Psychiatry Investig 2018; 15:279-284. [PMID: 29475242 PMCID: PMC5900365 DOI: 10.30773/pi.2017.08.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the effectiveness of usual care management (UCM) and a newly-developed lifestyle modification with contingency management (LMCM) for geriatric depressive symptoms in the community. METHODS A randomized controlled trial was conducted in 93 older adults with major depressive disorder at community mental health centers. A 12 week multi-domain LMCM was developed by providing positive reinforcement using 'gold medal stickers' as a symbolic incentive to motivate their participation and adherence. Participants were allocated to LMCM (n=47) and UCM (n=46) groups. They were then subjected to the 12 week treatment. Effects of the two intervention methods on Geriatric Depression Scale were determined using mixed model analysis. RESULTS Participants in the LMCM group had greater decline in GDS score per month than participants in the UCM group after adjusting for age, sex, years of education, living alone, and MMSE scores at baseline examination [coefficient for GDS score (95% CI): -1.08 (-1.51, -0.65), p<0.001, reference: UCM group]. CONCLUSION LMCM is safe and easy to use with a low cost. LMCM is suitable as psychosocial intervention for older adults with depressive symptoms in the community.
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Affiliation(s)
- Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kang Soo Lee
- Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Seongnam, Republic of Korea
| | - Eun Hee Lee
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jinju Kim
- Department of Psychiatry, Ajou Danam Hospital, Suwon, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
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Gitlin LN, Parisi JM, Huang J, Winter L, Roth DL. Valuation of Life as outcome and mediator of a depression intervention for older African Americans: the Get Busy Get Better Trial. Int J Geriatr Psychiatry 2018; 33:e31-e39. [PMID: 28401587 PMCID: PMC5788279 DOI: 10.1002/gps.4710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/06/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Previously, we showed that Get Busy Get Better (GBGB), a 10-session multicomponent home-based, behavioral intervention, reduced depressive symptom severity in older African Americans. As appraising the value of life is associated with depressive symptoms, this study examined whether GBGB enhanced positive appraisals of life and if, in turn, this mediated treatment effects on depressive symptoms. METHODS Data were from a single-blind parallel randomized trial involving 208 African Americans (≥55 years old) with depressive symptoms (Patient Health Questionnaire, PHQ-9 ≥5). GBGB involved five components: care management, referral/linkage, stress reduction, depression education, and behavioral activation. A 13-item Valuation of Life (VOL) scale with two subfactors (optimism and engagement) was examined as an outcome and as mediating GBGB effects on PHQ-9 scores at 4 months. RESULTS Of 208 enrolled African Americans, 180 completed the 4-month interview (87 = GBGB; 93 = control). At 4 months, compared with wait-list control group participants, the GBGB group had improved VOL (difference in mean changes from baseline = 4.67, 95% confidence interval 2.53, 6.80). Structural equation models indicated that enhanced VOL mediated a significant proportion of GBGB's impact on depressive symptoms, explaining 71% of its total effect, and its subfactors (optimism, explaining 67%; engagement, 52%). CONCLUSION Valuation of Life appears malleable through an intervention providing resources and activation skills. GBGB's impact on depressive symptoms is attributed in large part to participants' enhanced attachment to life. Attention to VOL as mediator and outcome and the reciprocal relationship between mood and attachment to life is warranted. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Laura N. Gitlin
- Professor/Director, Center for Innovative Care in Aging, Johns Hopkins University, 525 North Wolfe Street, Suite 316, Baltimore, MD 21205
| | - Jeanine M. Parisi
- Associate Scientist, Johns Hopkins University Bloomberg School of Public Health, Principal Faculty, Center for Innovative Care in Aging, 525 N Wolfe Street, Suite 424, Baltimore, MD 21205, T: 410-955-0412, F:410-955-9088
| | - Jin Huang
- Biostatistician, Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University. 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205
| | - Laraine Winter
- Senior Research Associates, School of Nursing, Villanova University, 800 E. Lancaster Ave., Villanova, PA.19085
| | - David L. Roth
- Professor, Director, Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205, T: 410-955-0491
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8
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Anguera JA, Gunning FM, Areán PA. Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial. Depress Anxiety 2017; 34:508-517. [PMID: 28052513 PMCID: PMC6093618 DOI: 10.1002/da.22588] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/14/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol. METHODS In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard. RESULTS EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence. CONCLUSIONS This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings.
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Affiliation(s)
- Joaquin A. Anguera
- Department of Neurology, University of California, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Faith M. Gunning
- Department of Psychiatry, Weil Cornell Medicine, New York, NY, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington
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When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-015-9313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Smith PD, Becker K, Roberts L, Walker J, Szanton SL. Associations among pain, depression, and functional limitation in low-income, home-dwelling older adults: An analysis of baseline data from CAPABLE. Geriatr Nurs 2016; 37:348-352. [PMID: 27245384 DOI: 10.1016/j.gerinurse.2016.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 04/19/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
A complex relationship exists between pain, depression, and functional limitation. These conditions, which substantially impact health care spending and quality of life, remain under-addressed in the current system of health care delivery, particularly among low-income and minority populations. This analysis uses baseline assessment data from CAPABLE, an ongoing randomized controlled trial (RCT), to examine associations between pain, depression, and functional limitation among a sample of low-income, community-dwelling elders with functional limitations. Linear regression revealed close associations between depression, pain, and activity of daily living (ADL) limitation. Mediation analyses indicated that depression fully mediated the relationship between pain intensity and functional limitation and partially mediated the relationship between pain interference and depression. Past research has shown that these conditions may be easily identified using validated assessment tools and effectively addressed through the introduction of interdisciplinary interventions. Several recommendations are presented for clinicians and health care organizations.
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Affiliation(s)
- Patrick D Smith
- Villanova University College of Nursing, 800 Lancaster Ave., Villanova, PA 19085, USA.
| | - Kathleen Becker
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Laken Roberts
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Janiece Walker
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Sarah L Szanton
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA; Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults. Int J Geriatr Psychiatry 2016; 31:526-35. [PMID: 26437368 DOI: 10.1002/gps.4358] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) affects many older adults and is associated with poor medical and mental health outcomes. Problem Solving Therapy (PST) has emerged as a promising psychotherapy for MDD in older adults, although the efficacy of PST in this population has not been well described. We examined the effectiveness of PST for the treatment of MDD in older adults in a systematic review and meta-analysis. METHODS We searched electronic databases to identify randomized controlled trials comparing PST to a control condition or other treatment for MDD in adults with an average age of 60 years or older. We used meta-analysis to arrive at pooled summary measures of the efficacy of PST when compared to control conditions on the change in depressive symptoms and other outcomes. RESULTS Nine studies with a total of 569 participants (290 PST, 279 control) met inclusion criteria. Most studies administered PST in person and were between 6 and 12 weeks in duration. Meta-analysis of six studies evaluating the effect of PST on depression using the Hamilton Rating Scale for Depression identified a significant reduction in depression associated with PST (pooled mean difference = -6.94, 95%CI -10.91 to -2.97, d = 1.15, P = 0.0006). PST was also effective in reducing disability in studies reporting this outcome. CONCLUSIONS Our review supports the existing research literature on PST suggesting that it is an effective treatment for older people with MDD. Further study is required to understand long-term outcomes associated with PST and its efficacy when compared to other treatments.
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Affiliation(s)
- Julia G Kirkham
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
| | - Namkee Choi
- School of Social Work, University of Texas at Austin, TX, USA
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care Mental Health Services, Kingston, ON, Canada
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Hoeft TJ, Hinton L, Liu J, Unützer J. Directions for Effectiveness Research to Improve Health Services for Late-Life Depression in the United States. Am J Geriatr Psychiatry 2016; 24:18-30. [PMID: 26525996 PMCID: PMC4706767 DOI: 10.1016/j.jagp.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 06/20/2015] [Accepted: 07/07/2015] [Indexed: 11/23/2022]
Abstract
Considerable progress has been made in the treatment of late-life depression over the past 20 years, yet considerable gaps in care remain. Gaps in care are particularly pronounced for older men, certain racial and ethnic minority groups, and those with comorbid medical or mental disorders. We reviewed the peer-reviewed literature and conducted interviews with experts in late-life depression to identify promising directions for effectiveness research to address these gaps in care. We searched the PubMed, PsychInfo, and CINHAL databases between January 1, 1998, through August 31, 2013, using terms related to late-life depression and any of the following: epidemiology, services organization, economics of care, underserved groups including health disparities, impact on caregivers, and interventions. The results of this selective review supplemented by more current recommendations from national experts highlight three priority research areas to improve health services for late-life depression: focusing on the unique needs of the patient through patient-centered care and culturally sensitive care, involving caregivers outside the traditional clinical care team, and involving alternate settings of care. We build on these results to offer five recommendations for future effectiveness research that hold considerable potential to advance intervention and health services development for late-life depression.
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Affiliation(s)
- Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jessica Liu
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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13
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Areán PA, Raue PJ, McCulloch C, Kanellopoulos D, Seirup JK, Banerjee S, Kiosses DN, Dwyer E, Alexopoulos GS. Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults. Am J Geriatr Psychiatry 2015; 23:1307-1314. [PMID: 26628206 PMCID: PMC6033321 DOI: 10.1016/j.jagp.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability. METHODS Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used. RESULTS Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12. CONCLUSION CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865).
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Affiliation(s)
- Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Patrick J Raue
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Dora Kanellopoulos
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Joanna K Seirup
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Samprit Banerjee
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Dimitris N Kiosses
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Eleanor Dwyer
- San Mateo Department of Public Health, San Mateo, CA
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Depression in elderly people living in rural Nigeria and its association with perceived health, poverty, and social network. Int Psychogeriatr 2015; 27:2009-15. [PMID: 26265242 DOI: 10.1017/s1041610215001088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The relationship between late-life depression, poverty, social network, and perceived health is little studied in Africa; the magnitude of the problem remains largely unknown and there is an urgent need to research into this area. METHODS We interviewed community dwelling elderly persons of two rural areas in Nigeria using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-30). Those who scored 11 and above on the GDS-30 were further interviewed using Geriatric Mental State Schedule (GMSS). Diagnosis of depression was based on the International Classification of Diseases 10th edition (ICD-10) and GMSS-Automated Geriatric Examination for Computer Assisted Taxonomy (GMMS-AGECAT). RESULTS A total of 458 community dwelling elderly persons participated in the study of which 57% were females. Mean age of the participants was 73.65(±7.8) years (95% CI 72.93-74.37). The mean GDS-30 and MMSE scores were 4.15(±4.80) and 21.73(±4.67), respectively. A total of 59 and 58 participants had depression based on ICD-10 criteria and GMSS-AGECAT, respectively. Agreement between ICD-10 and AGECAT diagnoses was κ = 0.931. By multiple logistic regression analysis, late-life depression was significantly associated with financial difficulties (Odds ratio 4.52 and bereavement Odds ratio 2.70). CONCLUSION Late-life depression in this cohort is associated with health and socio-economic factors that are worth paying attention to, in a region of economic deprivation and inadequate healthcare.
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Li J, Theng YL, Foo S. Depression and Psychosocial Risk Factors among Community-Dwelling Older Adults in Singapore. J Cross Cult Gerontol 2015; 30:409-22. [DOI: 10.1007/s10823-015-9272-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Barrera TL, Cully JA, Amspoker AB, Wilson NL, Kraus-Schuman C, Wagener PD, Calleo JS, Teng EJ, Rhoades HM, Masozera N, Kunik ME, Stanley MA. Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants. J Anxiety Disord 2015; 33:72-80. [PMID: 26005839 PMCID: PMC4479977 DOI: 10.1016/j.janxdis.2015.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 01/18/2023]
Abstract
Cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n = 101) and community-based (n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < 0.01), but not in Veterans (all ps > 0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps < 0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support.
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Affiliation(s)
- Terri L Barrera
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States.
| | - Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States
| | - Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Nancy L Wilson
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Cynthia Kraus-Schuman
- Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Paula D Wagener
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Jessica S Calleo
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Ellen J Teng
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States
| | - Howard M Rhoades
- Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nicholas Masozera
- Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States
| | - Melinda A Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, United States
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Przekop P, Haviland MG, Oda K, Morton KR. Prevalence and correlates of pain interference in older adults: why treating the whole body and mind is necessary. J Bodyw Mov Ther 2015; 19:217-25. [PMID: 25892375 PMCID: PMC4517937 DOI: 10.1016/j.jbmt.2014.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Our study presents pain-related interference rates in a sample of community-dwelling, older adults and determines factors associated with these restrictions. Participants were 9506 respondents to the Biopsychosocial Religion and Health Study (66.8% female and 33.2% male; average age = 62.3 years). In this sample, 48.2% reported no pain-related interference, whereas 37.7% reported moderate and 14.1% reported severe interference. As hypothesized, older age, female gender, lower education, financial strain, traumatic experiences, worse health, increased body mass index, poor sleep, and depressive symptoms all were associated with higher pain interference ratings (ordered logistic regression/three-level pain criterion; odds ratios p < 0.05). Our findings are similar to those from younger adults, and they suggest enduring effects of trauma on health and reveal the complexity of chronic pain in community-dwelling, older adults.
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Affiliation(s)
- Peter Przekop
- Betty Ford Center, 39000 Bob Hope Drive, Rancho Mirage, CA 92270, USA; Department of Pediatrics, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA; Department of Psychiatry, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA; Department of Neurology, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA.
| | - Mark G Haviland
- Department of Psychiatry, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA
| | - Keiji Oda
- Department of Epidemiology and Biostatistics, Loma Linda University, School of Public Health, Loma Linda, CA 92350, USA
| | - Kelly R Morton
- Department of Family Medicine, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA; Department of Psychology, Loma Linda University, School of Behavioral Health, Loma Linda, CA 92350, USA
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Simon SS, Cordás TA, Bottino CMC. Cognitive Behavioral Therapies in older adults with depression and cognitive deficits: a systematic review. Int J Geriatr Psychiatry 2015; 30:223-33. [PMID: 25521935 DOI: 10.1002/gps.4239] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/28/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to investigate the effectiveness of cognitive behavioral therapies (CBTs) in improving depressive symptoms, disability, and cognition in older adults with depression and cognitive deficits. DESIGN It was performed a systematic search for articles published between 1994 and February 2014 in the MEDLINE/Pubmed, PsycINFO, and SCIELO. The studies should have provided information about benefits after CBTs to older adults with depression and cognitive deficits. RESULTS Cognitive behavioral therapy focused on problem solving is the main approach studied, having better effectiveness than supportive therapy in randomized clinical trials. Significant improvements in mood and disability were consistent, although evidence of changes in cognitive measures is controversial, less studied, and limited. Nevertheless, improvements in executive functions, processing speed, and changes in patients' perspectives of problem solving skills, such as generating alternatives and decision-making, were described. Also, it would be necessary that future studies more often evaluate cognitive status of depressed elders, as well as cognitive changes after psychotherapy. It should be emphasized that there is a lack of studies in this field, and more approaches in CBTs need to be investigated to this population. CONCLUSION Older adults with depression and cognitive deficits can benefit from CBTs. Improvements in mood and disability are more consistent than changes in cognition, which are little studied after CBTs. It is necessary more studies in the field, as well as, to investigate more approaches in CBTs to older adults with depression and cognitive deficits.
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Affiliation(s)
- Sharon Sanz Simon
- Old Age Research Group (PROTER), Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil
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Hasche LK, Lavery A. "As needed" case management across aging services in response to depression. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2015; 58:272-288. [PMID: 25587880 DOI: 10.1080/01634372.2014.1001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/19/2014] [Indexed: 06/04/2023]
Abstract
A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. We used in-depth interviews with managers (n = 20) and staff surveys (n = 142) from 17 service agencies to explore the provision of case management services in adult day services, homecare, senior centers, and supportive housing. Limited case management services were found. Barriers included limited time and resources, especially for senior centers and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings.
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Affiliation(s)
- Leslie K Hasche
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
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Gitlin LN, Roth DL, Huang J. Mediators of the impact of a home-based intervention (beat the blues) on depressive symptoms among older African Americans. Psychol Aging 2014; 29:601-11. [PMID: 25244479 DOI: 10.1037/a0036784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Older African Americans (N = 208) with depressive symptoms were randomly assigned to a home-based nonpharmacologic intervention (Beat the Blues, or BTB) or wait-list control group. BTB was delivered by licensed social workers and involved up to 10 home visits focused on care management, referral and linkage, depression knowledge and efficacy in symptom recognition, instruction in stress reduction techniques, and behavioral activation through identification of personal goals and action plans for achieving them. Structured interviews by assessors masked to study assignment were used to assess changes in depressive symptoms (main trial endpoint), behavioral activation, depression knowledge, formal care service utilization, and anxiety (mediators) at baseline and 4 months. At 4 months, the intervention had a positive effect on depressive symptoms and all mediators except formal care service utilization. Structural equation models indicated that increased activation, enhanced depression knowledge, and decreased anxiety each independently mediated a significant proportion of the intervention's impact on depressive symptoms as assessed with 2 different measures (PHQ-9 and CES-D). These 3 factors also jointly explained over 60% of the intervention's total effect on both indicators of depressive symptoms. Our findings suggest that most of the impact of BTB on depressive symptoms is driven by enhancing activation or becoming active, reducing anxiety, and improving depression knowledge/efficacy. The intervention components appear to work in concert and may be mutually necessary for maximal benefits from treatment to occur. Implications for designing tailored interventions to address depressive symptoms among older African Americans are discussed.
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Affiliation(s)
- Laura N Gitlin
- School of Nursing Center for Innovative Care in Aging, Johns Hopkins University
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
| | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
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21
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Arean PA, Niu G. Choosing treatment for depression in older adults and evaluating response. Clin Geriatr Med 2014; 30:535-51. [PMID: 25037294 DOI: 10.1016/j.cger.2014.04.005] [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: 10/25/2022]
Abstract
An update is provided on the current information regarding late life depression with regard to assessment, clinical implications, and treatment recommendations. Several treatments are considered evidence-based, but when deployed into field trials, the efficacy of these treatments falls short. It is thought that the lower impact in community trials is due in large part to patient, clinical, environmental, socio-economic, and cognitive correlates that influence treatment response. The aim is to assist providers in making decisions about what type of treatment to recommend based on a sound assessment of these clinical correlates.
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Affiliation(s)
- Patricia A Arean
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Grace Niu
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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Ghio L, Vaggi M, Amore M, Ferrannini L, Natta W. Unmet needs and research challenges for late-life mood disorders. Aging Clin Exp Res 2014; 26:101-14. [PMID: 24078460 DOI: 10.1007/s40520-013-0149-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
Mood disorders are common and often under-recognised in older people whereby, together with the general ageing of the population, they are becoming a significant and growing public health problem worldwide. However, the need to address the problem of late life mood disorders in a real-world setting is met with a surprising lack of strong evidence in this field. Randomised clinical trials which focus on elderly mood disorders are not very common and the majority of them focus on pharmacological treatment of major depression. The aim of this study was to review first the main unmet needs and research challenges in late-life mood disorders as a basis to then review the state of the art evidence resulting from randomised clinical trials and the main critical aspects of their implementation. Comorbidity as well as polypharmacy, cognitive decline, unpredictable placebo response, and uncertainty on optimal duration of trials are some of the challenges the investigator has to address. Moreover, some methodological limitations of randomised clinical trials reduce the applicability of the results of such studies to common clinical practices and have encouraged some authors to investigate the existence of possible alternative research designs such as pragmatic randomised clinical trials.
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Abstract
We systematically reviewed randomized clinical trials of problem-solving therapy (PST) in older adults. Our results indicate that PST led to greater reduction in depressive symptoms of late-life major depression than supportive therapy (ST) and reminiscence therapy. PST resulted in reductions in depression comparable with those of paroxetine and placebo in patients with minor depression and dysthymia, although paroxetine led to greater reductions than placebo. In home health care, PST was more effective than usual care in reducing symptoms of depression in undiagnosed patients. PST reduced disability more than ST in patients with major depression and executive dysfunction. Preliminary data suggest that a home-delivered adaptation of PST that includes environmental adaptations and caregiver involvement is efficacious in reducing disability in depressed patients with advanced cognitive impairment or early dementia. In patients with macular degeneration, PST led to improvement in vision-related disability comparable to that of ST, but PST led to greater improvement in measures of vision-related quality of life. Among stroke patients, PST participants were less likely to develop a major or minor depressive episode than those receiving placebo treatment, although the results were not sustained in a more conservative statistical analysis. Among patients with macular degeneration, PST participants had significantly lower 2-month incidence rates of major depression than usual care participants and were less likely to suffer persistent depression at 6 months. Finally, among stroke patients, PST participants were less likely to develop apathy than those receiving placebo treatment. PST also has been delivered via phone, Internet, and videophone, and there is evidence of feasibility and acceptability. Further, preliminary data indicate that PST delivered through the Internet resulted in a reduction in depression comparable with that of in-person PST in home-care patients. PST delivered via videophone results in an improvement in hospice caregivers' quality of life and a reduction in anxiety comparable to those of in-person PST. PST-treated patients with cognitive impairment may require additional compensatory strategies, such as written notes, memory devices, environmental adaptations, and caregiver involvement.
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Affiliation(s)
- Dimitris N Kiosses
- Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College
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Karlin BE, Karel MJ. National Integration of Mental Health Providers in VA Home-Based Primary Care: An Innovative Model for Mental Health Care Delivery With Older Adults. THE GERONTOLOGIST 2013; 54:868-79. [DOI: 10.1093/geront/gnt142] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bradley E. Karlin
- Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michele J. Karel
- Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia
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Choi NG, Marti CN, Bruce ML, Hegel MT. Depression in homebound older adults: problem-solving therapy and personal and social resourcefulness. Behav Ther 2013; 44:489-500. [PMID: 23768675 PMCID: PMC3971531 DOI: 10.1016/j.beth.2013.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 04/06/2013] [Accepted: 04/07/2013] [Indexed: 11/27/2022]
Abstract
The goal of problem-solving therapy is to teach patients systematic coping skills. For many homebound older adults, coping skills must also include both personal and social (help-seeking) resourcefulness. This study aimed to examine the relationship between perceived resourcefulness and depressive symptoms at postintervention and potential mediating effect of the resourcefulness among 121 low-income homebound older adults who participated in a pilot randomized controlled trial testing feasibility and preliminary efficacy of telehealth-PST. Resourcefulness Scale for Older Adults was used to measure personal and social resourcefulness. Only personal resourcefulness scores were significantly associated with depression outcomes at postintervention, and neither resourcefulness scores were significantly associated with group assignment. Analysis found no mediation effect of resourcefulness. The findings call for further research on potential mediators for the potentially effective depression treatment that could be sustained in the real world for low-income homebound older adults who have limited access to psychotherapy as a treatment modality.
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Choi NG, Hegel MT, Marinucci ML, Sirrianni L, Bruce ML. Association between participant-identified problems and depression severity in problem-solving therapy for low-income homebound older adults. Int J Geriatr Psychiatry 2012; 27:491-9. [PMID: 21638330 PMCID: PMC3196815 DOI: 10.1002/gps.2741] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 04/04/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the relationship between the severity of baseline depressive symptoms and the problems that low-income homebound older adults (n = 66) identified in their problem-solving therapy (PST) sessions. METHODS Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). Participant-identified problems recorded in the therapists' worksheets were coded into seven categories: living arrangement/housing issues, financial/health care expense issues, family or other relationship issues, hygiene/task issues, social isolation issues, physical/functional health issues, and mental/emotional health issues. T-tests and ordinary least squares regression analyses were used to examine differences in HAMD scores between those who identified any problem in each category and those who did not. RESULTS Participants who had living arrangement/housing and family or other relationship issues had higher baseline HAMD scores than the rest of the participants. At 2-week posttest, those with living arrangement/housing issues continued to have higher HAMD scores than the others, whereas those with family or other relationship issues did not. CONCLUSION The study findings provide insights into the problems that low-income, depressed homebound individuals bring to their PST sessions. It was not clear if family conflict or other relationship issues contributed to their depression or vice versa, but it appears that PST may have contributed to alleviating depressive symptoms associated with these issues. Precarious living/housing situations appeared to have had a serious depressogenic effect and could not be easily resolved within a short time frame of the PST process, as these issues required formal support.
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Byers AL, Arean PA, Yaffe K. Low use of mental health services among older Americans with mood and anxiety disorders. Psychiatr Serv 2012; 63:66-72. [PMID: 22227762 PMCID: PMC3726310 DOI: 10.1176/appi.ps.201100121] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It is unclear why late-life mood and anxiety disorders are highly undertreated, despite being common among older adults. Thus this study examined prevalence of and key factors associated with nonuse of mental health services among older community-dwelling adults with these disorders. METHODS The sample included 348 participants aged 55 years or older who met 12-month criteria for DSM-IV mood and anxiety disorders and responded to the National Comorbidity Survey Replication (NCS-R), a population-based probability sample. Analyses included frequency measures and logistic regression with weights and complex design-corrected statistical tests. Key factors associated with not using mental health services were determined in a final multivariable model based on a systematic approach that accounted for a comprehensive list of potential predictors. RESULTS Approximately 70% of older adults with mood and anxiety disorders did not use services. Those who were from racial-ethnic minority groups, were not comfortable with discussing personal problems, were married or cohabitating, and had middle- versus high-income status had increased odds of not using mental health services. In addition, respondents with mild versus serious disorders, no chronic pain complaints, and low versus high perceived cognitive impairment had greater odds of nonuse. CONCLUSIONS Results indicate that improvements are needed in the following areas to combat the very high number of mood and anxiety disorders that go untreated in older Americans: awareness of need, comfort in discussing personal problems with a health care professional, and screening and other prevention efforts.
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Affiliation(s)
- Amy L Byers
- Department of Psychiatry, University of California, San Francisco (UCSF), 4150 Clement St. (116H), San Francisco, CA 94121, USA.
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Chu JP, Huynh L, Areán P. Cultural adaptation of evidence-based practice utilizing an iterative stakeholder process and theoretical framework: problem solving therapy for Chinese older adults. Int J Geriatr Psychiatry 2012; 27:97-106. [PMID: 21500283 PMCID: PMC3239220 DOI: 10.1002/gps.2698] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/10/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Main objectives were to familiarize the reader with a theoretical framework for modifying evidence-based interventions for cultural groups, and to provide an example of one method, Formative Method for Adapting Psychotherapies (FMAP), in the adaptation of an evidence-based intervention for a cultural group notorious for refusing mental health treatment. METHODS Provider and client stakeholder input combined with an iterative testing process within the FMAP framework was utilized to create the Problem Solving Therapy--Chinese Older Adult (PST-COA) manual for depression. Data from pilot-testing the intervention with a clinically depressed Chinese elderly woman are reported. RESULTS PST-COA is categorized as a 'culturally-adapted' treatment, where core mediating mechanisms of PST were preserved, but cultural themes of measurement methodology, stigma, hierarchical provider-client relationship expectations, and acculturation enhanced core components to make PST more understandable and relevant for Chinese elderly. Modifications also encompassed therapeutic framework and peripheral elements affecting engagement and retention. PST-COA applied with a depressed Chinese older adult indicated remission of clinical depression and improvement in mood. Fidelity with and acceptability of the treatment was sufficient as the client completed and reported high satisfaction with PST-COA. CONCLUSIONS PST, as a non-emotion-focused, evidence-based intervention, is a good fit for depressed Chinese elderly. Through an iterative stakeholder process of cultural adaptation, several culturally-specific modifications were applied to PST to create the PST-COA manual. PST-COA preserves core therapeutic PST elements but includes cultural adaptations in therapeutic framework and key administration and content areas that ensure greater applicability and effectiveness for the Chinese elderly community.
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Renfro MO, Fehrer S. Multifactorial Screening for Fall Risk in Community-Dwelling Older Adults in the Primary Care Office. J Geriatr Phys Ther 2011; 34:174-83. [DOI: 10.1519/jpt.0b013e31820e4855] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clark S. Integration of supportive psychotherapy with case management for older adults with borderline personality disorder. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2011; 54:627-638. [PMID: 21780885 DOI: 10.1080/01634372.2011.585391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article attempts to demonstrate how supportive psychotherapy may serve as a companion therapeutic modality for case management activities with older adult clients suffering with borderline personality disorder (BPD). Justification for this approach is provided and techniques and interventions are identified. Three case examples demonstrating the modalities integration are provided.
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Affiliation(s)
- Steven Clark
- Department of Social Welfare, University of California-Los Angeles, Lusckin School of Public Affairs, Los Angeles, CA 90095-1656, USA.
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32
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Treating Depression During a Recession: Psychotherapy with Indigent Clients. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2011. [DOI: 10.1007/s10879-011-9193-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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