Is group psychotherapy effective in older adults with depression? A systematic review

KRISHNA Murali, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 26(4), April 2011, pp.331-340.

The evidence from earlier reviews and meta-analyses lead to the conclusion that psychological treatment of depression is effective in older adults. The authors conducted a systematic review specifically looking at group psychotherapy. Electronic databases were searched to identify randomised controlled trials, selected studies were quality assessed and data extracted by two reviewers. Six trials met the inclusion criteria. These trials examined group interventions based on the cognitive behavioural therapy model with active therapeutic interventions (such as reminiscence therapy) or waiting list controls. The analyses indicate that group psychotherapy is an effective intervention in older adults with depression in comparison to waiting list controls but the overall effect size is very modest. The reported benefits of group intervention in comparison to other active interventions did not reach statistical significance. The benefits of group psychotherapy were maintained at follow-up. The authors note that the quality of the studies was variable, and not always optimal, and that most of the work involved the younger old so may not be transferable to the very elderly. Overall they conclude that group cognitive behavioural therapy is effective in older adults with depression.

Extended abstract:

KRISHNA Murali; et al.;

Is group psychotherapy effective in older adults with depression? A systematic review.

Journal citation/publication details

International Journal of Geriatric Psychiatry, 26(4), April 2011, pp.331-340.


Group cognitive behaviour therapy was found to have a modest effect on depression compared with waiting list controls, but no significant effect compared to other active therapy. The evidence is limited by the small number of studies included, i.e. six, and their relatively small size. Other limitations include a high attrition rate, and the wide variability in study populations, intervention characteristics, and methods.  


Depression in older adults is widely under-recognised and undertreated. The combination of psychotherapy and pharmacological treatment could provide additional benefits to members of this population, who are often socially isolated. Such an approach may also result in more cost effective and timely treatment. This systematic review and meta-analysis was prompted by the need for up to date evidence.


What sources were searched?
The online databases Medline, EMBASE, PsycINFO, CINAHL, Cochrane Reviews and the Cochrane Central Register of Controlled Trials were searched up to April 2009. Dissertation Abstracts was searched for unpublished studies and information was sought from organisations providing evidence and good practice guidelines, including NICE, the Society of Psychotherapy Research, and the British Association of Psychotherapy. Reference lists were searched for additional studies and the indexing of key papers was examined to ensure that relevant articles had not been missed. Three journals were searched manually for the two previous years; they were the British Journal of Psychiatry, the International Journal of Geriatric Psychiatry, and the British Journal of Psychotherapy.

What search terms/strategies were used?
The search terms ‘depression’, ‘dysthymia’, and ‘adjustment disorder’ were combined with ‘group therapy’, ‘cognitive therapy’, ‘behaviour therapy’, and ‘psychotherapy’. Details of specific searches are not included.

What criteria were used to decide on which studies to include?
Randomised and cluster-randomised controlled trials in adults with depression, aged 50 years or older, taking part in formalised psychotherapeutic treatment within a group setting were included in the review. Depression had to be diagnosed using standard diagnostic criteria. Group therapy was defined as including three or more members. Studies of patients with significant cognitive impairment, primary mental illness, patients with psychotic symptoms, and those with a primary diagnosis of drug or alcohol dependence were excluded.  Qualitative studies and reviews were also excluded.

Who decided on their relevance and quality?
Studies were initially screened based on the abstracts; potentially relevant trials were then screened in full. The screening process is not described in detail. The number of articles excluded at each stage of the process and the reasons for exclusion are presented in Figure 1. Study quality was assessed using the Quality Rating Scale and the parameters set by Higgins and Green, 2005, by two named authors working independently.

How many studies were included and where were they from?
A total of 360 studies was identified, 64 of which were screened in full. Eleven studies met the inclusion criteria but only six presented the change in depression scores as continuous variables along with mean and standard deviations, and could therefore be included in the meta-analyses. Five of the studies were from the USA and one was from Germany.

How were the study findings combined?
Data was extracted using a standardised data extraction tool and subjected to meta-analysis. Changes in outcome were recorded and dropout rates were calculated.


Findings of the review

All six of the included studies were randomised controlled trials with parallel design in patients with at least mild to moderate depression. Study quality ranged from 20 to 33 out of a maximum possible score of 46 and is described as ‘reasonable’ overall. In half of the studies control groups received other forms of active treatment, such as reminiscence, educational activities, and visual imagery; the other three studies used waiting list patients. The majority of the trials were small and had fewer than 30 participants in each arm. All the psychotherapeutic interventions were based on the cognitive behavioural model with a mean number of weekly sessions of 12.8 and mean duration of follow-up of 11.3 months.

Meta-analysis revealed that group psychotherapy was effective compared to waiting list controls, but the overall effect size was modest; the effects were maintained at follow-up. Outcomes measured on the Hamilton Depression Rating Scale showed greater intervention effect sizes than outcomes measured on the Becks Depression Inventory or the Geriatric Depression Scale. There were no statistically significant beneficial effects of group psychotherapy compared to other active treatment.


Authors' conclusions

Although a modest effect size of group therapy was found compared with waiting list controls there was no advantage over other active treatment controls. The conclusions that can be drawn from this review are limited, particularly by the small number of eligible trials identified.  

Implications for policy or practice

None are discussed.

Subject terms:
literature reviews, older people, behaviour therapy, depression, group therapy;
Content type:
systematic review
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