TY - JOUR

T1 - Managing depression in older age

T2 - psychological interventions

AU - Cuijpers, Pim

AU - Karyotaki, Eirini

AU - Pot, A. M.

AU - Park, Mijung

AU - Reynolds, Charles F.

PY - 2014/10

Y1 - 2014/10

N2 - The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated meta-analysis of these studies. A total of 44 studies comparing psychotherapies to control groups, other therapies or pharmacotherapy could be included. The overall effect size indicating the difference between psychotherapy and control groups was g = 0.64 (95% CI: 0.47-0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g = 0.27; 95%CI: 0.16-0.37). Specific types of psychotherapies that were found to be effective included cognitive behavior therapy (g = 0.45; 95% CI: 0.29-0.60), life review therapy (g = 0.59; 95% CI: 0.36-0.82) and problem-solving therapy (g = 0.46; 95% CI: 0.18-0.74). Treatment compared to waiting list control groups resulted in larger effect sizes than treatments compared to care-as-usual and other control groups (p < 0.05). Studies with lower quality resulted in higher effect sizes than high-quality studies (p < 0.05). Direct comparisons between different types of psychotherapy suggested that cognitive behavior therapy and problem-solving therapy may be more effective than non-directive counseling and other psychotherapies may be less effective than other therapies. This should be considered with caution, however, because of the small number of studies. There were not enough studies to examine the long-term effects of psychotherapies and to compare psychotherapy with pharmacotherapy or combined treatments. We conclude that it is safe to assume that psychological therapies in general are effective in late-life depression, and this is especially well-established for cognitive behavior therapy and problem-solving therapy.

AB - The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated meta-analysis of these studies. A total of 44 studies comparing psychotherapies to control groups, other therapies or pharmacotherapy could be included. The overall effect size indicating the difference between psychotherapy and control groups was g = 0.64 (95% CI: 0.47-0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g = 0.27; 95%CI: 0.16-0.37). Specific types of psychotherapies that were found to be effective included cognitive behavior therapy (g = 0.45; 95% CI: 0.29-0.60), life review therapy (g = 0.59; 95% CI: 0.36-0.82) and problem-solving therapy (g = 0.46; 95% CI: 0.18-0.74). Treatment compared to waiting list control groups resulted in larger effect sizes than treatments compared to care-as-usual and other control groups (p < 0.05). Studies with lower quality resulted in higher effect sizes than high-quality studies (p < 0.05). Direct comparisons between different types of psychotherapy suggested that cognitive behavior therapy and problem-solving therapy may be more effective than non-directive counseling and other psychotherapies may be less effective than other therapies. This should be considered with caution, however, because of the small number of studies. There were not enough studies to examine the long-term effects of psychotherapies and to compare psychotherapy with pharmacotherapy or combined treatments. We conclude that it is safe to assume that psychological therapies in general are effective in late-life depression, and this is especially well-established for cognitive behavior therapy and problem-solving therapy.

KW - Health sciences

KW - depression

KW - Plder adults

KW - Psychotherapy

KW - cognitive behavior therapy

KW - life review

KW - Meta-analysis

KW - Psychology

UR - http://www.scopus.com/inward/record.url?scp=84916926028&partnerID=8YFLogxK

U2 - 10.1016/j.maturitas.2014.05.027

DO - 10.1016/j.maturitas.2014.05.027

M3 - Scientific review articles

C2 - 24973043

VL - 79

SP - 160

EP - 169

JO - Maturitas

JF - Maturitas

SN - 0378-5122

IS - 2

ER -