Article

Non-pharmacological prevention of major depression among community-dwelling older adults: A systematic review of the efficacy of psychotherapy interventions

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Archives of gerontology and geriatrics (Impact Factor: 1.85). 04/2012; 55(3):522-9. DOI: 10.1016/j.archger.2012.03.003
Source: PubMed

ABSTRACT

Depression is a major public health burden among the aging population. While older adults prefer non-pharmacological treatment, few options for psychotherapy are available in primary care settings, which is where older adults tend to receive mental health services. Indicated prevention is a cost-effective, public health approach to prevent major depressive disorder among people with depressive symptoms who do not yet meet standard criteria for major depression. We critically reviewed randomized controlled trials (RCTs) that assessed the efficacy of psychotherapy among community-dwelling older adults with subthreshold depression (depressive symptoms that do not meet standard criteria for major depression). We examined the intervention types, results, internal validity, and external validity of five studies. We used the United States Preventive Services Task Force (USPSTF) guidelines to rate the quality of the studies and to provide recommendations. Results suggest that psychotherapy is a safe and cost-effective method to reduce the public health burden of depression among older adults with subthreshold depression.

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    • "There is a general consensus that a broad range of psychosocial treatments are efficacious for treating psychological disorders in later life (Scogin & Shah, 2012). A series of meta-analyses and reviews supported the efficacy of psychosocial treatments for depression and anxiety in latemiddle aged to older adults (e.g., Gonçalves & Byrne, 2012; Lee et al., 2012). Researchers currently assert that intense and complex treatments such as prolonged exposure therapy are effective for older individuals (Clapp & Beck, 2012). "
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    ABSTRACT: Whether psychosocial treatments work equally well for late middle-aged and older men and women is unknown. For this critical review, sixteen studies were identified that examined psychosocial treatments for psychopathology in men age 55 and older. The preponderance of evidence showed that treatments worked at least as well in men as in women. Six studies reported statistically significant treatment effects in exclusively male participants. Methodological problems include weak research designs, small sample size, and absence of indication of clinical significance. There continues to be a paucity of research addressing the efficacy of psychosocial interventions for late middle-aged and older men. Researchers are encouraged to include racially and ethnically diverse older men in carefully controlled studies that examine clinically significant change. (120 words) Keywords: Psychotherapy, Gender Differences, Men, Psychosocial Intervention, Older adults
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