Author
CRABB Rebecca M.; et al.;
Title
Is computerized cognitive-behavioural therapy a treatment option for depression in late-life? A systematic review.
Journal citation/publication details
British Journal of Clinical Psychology, 51(4), November 2012, pp.459-464.
Summary
Thirty-two studies were included in this review of research published in the ten years up to 2010, nineteen of which were randomised controlled trials. The rate of participation of older adults was very low with no studies reporting separate data for the age group. Some evidence on dropout rates and difficulties in accessing or engaging in computerised CBT therapy was obtained from some of the authors but this is in the form of comments and observations.
Context
Computerised cognitive-behavioural therapy programmes have been used effectively in the treatment of depression and have allowed greater access to evidence-based care for depression. Older people could benefit from such treatment, despite being less likely than younger adults to be computer users, as the rate of Internet use for this older age group is reported to be on the increase. The aim of this study was to “determine the extent to which adults aged 65 years and older are represented in existing studies of CBBT for depression and describe available data on recruitment, retention, and outcomes”.
Methods
What sources were searched?
The electronic databases PubMED and PsycINFO were searched from January 2000 to the end of December 2010. The reference lists of retrieved articles were hand-searched for additional studies.
What search terms/strategies were used?
The terms ‘Internet’, ‘computers’, and ‘computerized’ (sic) were combined with ‘psychotherapy’, ‘CBT’ and ‘depression’ or ‘depressed’.
What criteria were used to decide on which studies to include?
Studies could be controlled, or uncontrolled, efficacy trials of web-based or CD-ROM cognitive-behavioural therapy for depression conducted in adult populations. Only articles published in English in peer-reviewed journals were eligible for inclusion. Studies in which disorders other than depression were the main focus were excluded but trials of co-morbid anxiety and depression were allowed.
Who decided on their relevance and quality?
Details of the study selection process are not included and there is no indication that studies were assessed for quality.
How many studies were included and where were they from?
A total of 328 articles was identified from the search strategy, 51 were retrieved in full for closer examination. Thirty-two studies were subsequently found to meet all of the eligibility criteria and are included in the review. The authors of 26 studies for which age-related data was not reported were contacted with a request for information on the percentage of their sample aged 65 years or older, and for details of any special challenges related to recruiting and retaining older participants in the studies. There were 16 studies from the United Kingdom, six from Sweden, nine from the Netherlands, six from the USA, 12 from Australia, and two from Germany.
How were the study findings combined?
Data on the age range of participants, the number of older adults included in the study sample and age-related differences in outcomes and rates of attrition was extracted from the studies.
Findings of the review
Nineteen of the 32 studies included in the review were randomised and controlled - the remainder were uncontrolled. Fourteen of the controlled trials and five of the uncontrolled trials included at least one participant aged 65 years or older. Seven trials explicitly excluded older people; none of the studies focused exclusively on adults aged 65 years and above. Data on the recruitment, attrition and outcomes for older adults was not reported separately in any of the trials.
Ten controlled trials and four uncontrolled trials included data on the number of older participants; the proportion ranged from 0.3 to 9.2% and 0.9 to 6.9%, respectively. Of the eleven authors that responded to the request for further comments, three said that older adults were less likely to drop out than younger participants, and two observed that attrition rates were similar between the age groups. Three authors also commented that older adults experienced greater technical challenges in accessing and engaging with the computerised programmes.
Authors' conclusions
“Our systematic review confirmed a low rate of participation by older adults in published clinical trials of computerised CBT for depression.”
Implications for policy or practice
None are discussed.