Clinical Effectiveness of Individual Cognitive Behavioral Therapy for Depressed Older People in Primary Care

Department of Mental Health Sciences, University College Medical School, Rowland Hill St, London NW3 2PF, England.
Archives of general psychiatry (Impact Factor: 14.48). 12/2009; 66(12):1332-40. DOI: 10.1001/archgenpsychiatry.2009.165
Source: PubMed


In older people, depressive symptoms are common, psychological adjustment to aging is complex, and associated chronic physical illness limits the use of antidepressants. Despite this, older people are rarely offered psychological interventions, and only 3 randomized controlled trials of individual cognitive behavioral therapy (CBT) in a primary care setting have been published.
To determine the clinical effectiveness of CBT delivered in primary care for older people with depression.
A single-blind, randomized, controlled trial with 4- and 10-month follow-up visits.
A total of 204 people aged 65 years or older (mean [SD] age, 74.1 [7.0] years; 79.4% female; 20.6% male) with a Geriatric Mental State diagnosis of depression were recruited from primary care.
Treatment as usual (TAU), TAU plus a talking control (TC), or TAU plus CBT. The TC and CBT were offered over 4 months.
Beck Depression Inventory-II (BDI-II) scores collected at baseline, end of therapy (4 months), and 10 months after the baseline visit. Subsidiary measures were the Beck Anxiety Inventory, Social Functioning Questionnaire, and Euroqol. Intent to treat using Generalized Estimating Equation and Compliance Average Causal Effect analyses were used.
Eighty percent of participants were followed up. The mean number of sessions of TC or CBT was just greater than 7. Intent-to-treat analysis found improvements of -3.07 (95% confidence interval [CI], -5.73 to -0.42) and -3.65 (95% CI, -6.18 to -1.12) in BDI-II scores in favor of CBT vs TAU and TC, respectively. Compliance Average Causal Effect analysis compared CBT with TC. A significant benefit of CBT of 0.4 points (95% CI, 0.01 to 0.72) on the BDI-II per therapy session was observed. The cognitive therapy scale showed no difference for nonspecific, but significant differences for specific factors in therapy. Ratings for CBT were high (mean [SD], 54.2 [4.1]).
Cognitive behavioral therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects. Identifier: ISRCTN18271323.

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Available from: Michael B King, Mar 19, 2015
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    • "Not surprisingly, psychological approaches such as CBT have been particularly effective in treating depression in medical patients who need help addressing maladaptive beliefs about their illness that initiate and maintain depression (Bower et al., 2000; Kessler et al., 2009; Serfaty et al., 2009; Ward et al., 2000). Most studies in primary care patients have compared CBTwith control conditions such as " usual care " by the physician, a " talking control " condition, or alternative forms of therapy such as nondirective counseling (Bower et al., 2000; Katon et al., 1996; Kessler et al., 2009; Serfaty et al., 2009; Ward et al., 2000). Head-to-head comparisons of varying forms of CBT are rare. "
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    • "It is important to note that the effects of CBT in this study were maintained at 3 years follow-up (9). A study conducted by Serfaty et al. (10) showed similar results. In this study, the sample comprised of geriatric primary care patients experiencing symptoms of depression. "
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    • "O'Hara, 2000 Dobkin, 2011 Grote, 2009 Mynors-Wallis, 1995 Berger, 2011 Fledderus, 2012 ACT-E Watt, 2000 Iteg Fledderus, 2012 ACT-M Scott, 2000 Choi, 2012 Harley, 2008 Vitriol, 2009 Miller, 2002 Watkins, 1993 IPT Serfaty, 2009 Dowrick, 2000 PST Laidlaw, 2008 Watkins, 1993 CBT Ward, 2000 NDC Van Schaik, 2006 Perini, 2009 Miranda, 2003 Dowrick, 2000 CWD Ward, 2001 CBT Talbot, 2011 Haringsma, 2006 Allart-van Dam, 2003 Simpson, 2003 Lynch, 2004 Neugebauer, 2006 Klein, 1985 "
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