Psychosocial Interventions for the Acute Treatment of Late-life Major Depression: A Systematic Review of Evidence-based Treatments, Predictors of Treatment Outcomes and Moderators of Treatment Effects

Department of Psychiatry, Weill-Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA.
The Psychiatric clinics of North America (Impact Factor: 1.87). 06/2011; 34(2):377-401, viii. DOI: 10.1016/j.psc.2011.03.001
Source: PubMed


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.

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    • "Notwithstanding the efficacy of CBT for late-life depression, clinicians and researchers have noted variability in treatment response, highlighting the need for identification of predictors of outcome (Kiosses et al., 2011). Previous studies have found that treatment response is not strongly influenced by demographic factors (e.g., age, gender, education) or co-morbid anxiety disorders; although, there is some evidence suggesting that those with more severe depressive symptomatology at baseline may show greater improvements at posttreatment (Kiosses et al., 2011). Given the limited amount of information available on predictors of response to CBT for late-life depression, the present study aimed to examine cortisol as a predictor of treatment response, which has not been tested previously in the context of CBT for geriatric depression. "
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    ABSTRACT: Previous studies suggest that individuals with elevated levels of cortisol (the "stress hormone") could be particularly resistant to treatment for depression. However, most of these studies have been conducted in the context of antidepressant medications, and no study has examined pretreatment cortisol levels as a predictor of treatment outcomes among older adults with depression in cognitive-behavioral therapy (CBT), despite the relevance of this population for such a research question. The current study includes 54 older adults with depression who provided salivary cortisol samples at baseline and completed measures of depression at pretreatment and posttreatment, following a 12-week course of CBT. Structural equation modeling results suggest that those with higher daily outputs of cortisol and flatter diurnal slopes were less likely to benefit from CBT-a finding which if replicated could have important implications for clinical practice and future research.
    Full-text · Article · Aug 2013 · Psychiatry Research
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    ABSTRACT: Although evidence-based depression interventions exist, relatively few older adults seek care from mental health specialists. Moreover, studies that examine the models used to deliver mental health services have been limited. In light of an aging and diversifying population, this article reviews current depression interventions for older adults in non-mental health clinics. A total of 21 articles were included in this review focusing on depression interventions conducted in primary care, home-based, and community-based settings. Notably, care manager-based interventions and problem solving interventions reduced depression across settings. Very few studies focused on racial/ethnic minority populations. Models of geriatric service delivery are highlighted and implications for ethnic minority older adults are discussed in light of health care reform.
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    Full-text · Article · Oct 2011 · The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry
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