International Journal of Geriatric Psychiatry, 32(9), 2017, pp.1009-1016.
Publisher:
Wiley
Objective: The generalisability of antidepressant efficacy trials (AETs) has been questioned. No studies have examined the inclusion/exclusion criteria used in placebo-controlled studies of late life depression and compared them to the criteria used in non-late life AETs.
Method: The authors conducted a comprehensive literature review of placebo-controlled AETs published from January, 1995 through December, 2014. They compared the inclusion/exclusion criteria used in the 18 studies of late life depression to those used in non-late life depression.
Results: There were nine inclusion/exclusion criteria that were used in more than half of the late life depression AETs: minimum severity on a symptom severity scale (100.0%), significant suicidal ideation (77.8%), psychotic features during the current episode of depression or history of a psychotic disorder (94.4%), history of bipolar disorder (77.8%), diagnosis of alcohol or drug abuse or dependence (83.3%), presence of a comorbid nondepressive, nonsubstance use Axis I disorder (55.6%), episode duration too short (66.7%), and an insufficient score on a cognitive screen (88.3%) or the presence of a cognitive disorder (55.6%). There were some differences between the late life and non-late life depression studies—use of a screening measure of cognitive functioning, presence of a cognitive disorder such as dementia, and the minimum depression severity cutoff score required at baseline.
Conclusions: The inclusion/exclusion criteria in AETs of late life depression were generally similar to the criteria used in non-late life depression
(Edited publisher abstract)
Objective: The generalisability of antidepressant efficacy trials (AETs) has been questioned. No studies have examined the inclusion/exclusion criteria used in placebo-controlled studies of late life depression and compared them to the criteria used in non-late life AETs.
Method: The authors conducted a comprehensive literature review of placebo-controlled AETs published from January, 1995 through December, 2014. They compared the inclusion/exclusion criteria used in the 18 studies of late life depression to those used in non-late life depression.
Results: There were nine inclusion/exclusion criteria that were used in more than half of the late life depression AETs: minimum severity on a symptom severity scale (100.0%), significant suicidal ideation (77.8%), psychotic features during the current episode of depression or history of a psychotic disorder (94.4%), history of bipolar disorder (77.8%), diagnosis of alcohol or drug abuse or dependence (83.3%), presence of a comorbid nondepressive, nonsubstance use Axis I disorder (55.6%), episode duration too short (66.7%), and an insufficient score on a cognitive screen (88.3%) or the presence of a cognitive disorder (55.6%). There were some differences between the late life and non-late life depression studies—use of a screening measure of cognitive functioning, presence of a cognitive disorder such as dementia, and the minimum depression severity cutoff score required at baseline.
Conclusions: The inclusion/exclusion criteria in AETs of late life depression were generally similar to the criteria used in non-late life depression
(Edited publisher abstract)
Subject terms:
depression, older people, literature reviews, mental health problems;
SARACINO Rebecca M., ROSENFELD Barry, NELSON Christian J.
Journal article citation:
Aging and Mental Health, 20(12), 2016, pp.1230-1242.
Publisher:
Taylor and Francis
Objectives: This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer.
Method: PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer.
Results: The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms.
Conclusions: Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.
(Edited publisher abstract)
Objectives: This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer.
Method: PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer.
Results: The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms.
Conclusions: Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.
(Edited publisher abstract)
Subject terms:
cancer, older people, depression, literature reviews;
International Journal of Geriatric Psychiatry, 26(4), April 2011, pp.331-340.
Publisher:
Wiley
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.
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:
Author
KRISHNA Murali; et al.;
Title 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.
Summary
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.
Context
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.
Methods
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;
Examines the extent and nature of the relationship between age-related vision and hearing impairments and depression and discuses the implications for practitioners working with elders who have sensory impairments. The article draws on recent research findings.
Examines the extent and nature of the relationship between age-related vision and hearing impairments and depression and discuses the implications for practitioners working with elders who have sensory impairments. The article draws on recent research findings.
Subject terms:
literature reviews, older people, visual impairment, depression, hearing impairment;
International Journal of Geriatric Psychiatry, 32(3), 2017, pp.247-255.
Publisher:
Wiley
Objective: Depression is known to negatively impact social functioning, with patients commonly reporting difficulties maintaining social relationships. Moreover, a large body of evidence suggests poor social functioning is not only present in depression but that social functioning is an important factor in illness course and outcome. In addition, good social relationships can play a protective role against the onset of depressive symptoms, particularly in late-life depression. However, the majority of research in this area has employed self-report measures of social function. This approach is problematic, as due to their reliance on memory, such measures are prone to error from the neurocognitive impairments of depression, as well as mood-congruent biases.
Method: Narrative review based on searches of the Web of Science and PubMed database(s) from the start of the databases, until the end of 2015.
Results: The present review provides an overview of the literature on social functioning in (late-life) depression and discusses the potential for new technologies to improve the measurement of social function in depressed older adults. In particular, the use of wearable technology to collect direct, objective measures of social activity, such as physical activity and speech, is considered.
Conclusion: In order to develop a greater understanding of social functioning in late-life depression, future research should include the development and validation of more direct, objective measures in conjunction with subjective self-report measures.
(Publisher abstract)
Objective: Depression is known to negatively impact social functioning, with patients commonly reporting difficulties maintaining social relationships. Moreover, a large body of evidence suggests poor social functioning is not only present in depression but that social functioning is an important factor in illness course and outcome. In addition, good social relationships can play a protective role against the onset of depressive symptoms, particularly in late-life depression. However, the majority of research in this area has employed self-report measures of social function. This approach is problematic, as due to their reliance on memory, such measures are prone to error from the neurocognitive impairments of depression, as well as mood-congruent biases.
Method: Narrative review based on searches of the Web of Science and PubMed database(s) from the start of the databases, until the end of 2015.
Results: The present review provides an overview of the literature on social functioning in (late-life) depression and discusses the potential for new technologies to improve the measurement of social function in depressed older adults. In particular, the use of wearable technology to collect direct, objective measures of social activity, such as physical activity and speech, is considered.
Conclusion: In order to develop a greater understanding of social functioning in late-life depression, future research should include the development and validation of more direct, objective measures in conjunction with subjective self-report measures.
(Publisher abstract)
Subject terms:
depression, older people, evaluation, prevention, literature reviews, relationships;
International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.773-781.
Publisher:
Wiley
This article reviews the literature regarding the naturalistic outcomes of minor and subsyndromal depression (Min/SSD) in older primary care patients, synthesizing and critiquing findings and discussing avenues for future research. The author obtained relevant articles from repeated computer-assisted literature searches over the past 15 years, and by reviewing the reference citations of the articles so obtained. A variety of relevant outcome domains were identified, as were important putative predictors, moderators, and mediators of outcome. In general, minor and subsyndromal depression each have comparable outcomes, outcomes that are clearly worse than non-depressed subjects, with substantially elevated risk of worsening into major depression, albeit not as poor as those with major depression. Min/SSD is common and of real clinical importance in primary care seniors. Several definitions of SSD may be used, each with overlapping but distinguishable utility in identifying patients. While the evidence base has expanded greatly in the past decade, considerable work remains to be done. Naturalistic studies of several outcome domains are needed, focusing on the predictive, moderating, and mediating roles of a wide range of psychopathological, medical, functional, and psychosocial factors. Such work will complement interventions and biomarker research approaches.
This article reviews the literature regarding the naturalistic outcomes of minor and subsyndromal depression (Min/SSD) in older primary care patients, synthesizing and critiquing findings and discussing avenues for future research. The author obtained relevant articles from repeated computer-assisted literature searches over the past 15 years, and by reviewing the reference citations of the articles so obtained. A variety of relevant outcome domains were identified, as were important putative predictors, moderators, and mediators of outcome. In general, minor and subsyndromal depression each have comparable outcomes, outcomes that are clearly worse than non-depressed subjects, with substantially elevated risk of worsening into major depression, albeit not as poor as those with major depression. Min/SSD is common and of real clinical importance in primary care seniors. Several definitions of SSD may be used, each with overlapping but distinguishable utility in identifying patients. While the evidence base has expanded greatly in the past decade, considerable work remains to be done. Naturalistic studies of several outcome domains are needed, focusing on the predictive, moderating, and mediating roles of a wide range of psychopathological, medical, functional, and psychosocial factors. Such work will complement interventions and biomarker research approaches.
Subject terms:
literature reviews, older people, outcomes, patients, primary care, depression;
Journal of Gerontological Social Work, 50(S1), 2008, pp.153-189.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Depression and anxiety and the most common mental health problems of later life, but relatively little is known about their unique manifestation in older adults. Moreover, much of the growing body of research on psychosocial interventions for this population has yet to be translated into practice. This systematically conducted review covers meta-analyses of interventions for late-life depression and anxiety; and primary research literature on the effectiveness of cognitive-behavioural therapy, interpersonal therapy and reminiscence therapy. The review also looks at combined (pharmacological/psychosocial) treatments and other non-pharmacological approaches (e.g. exercise), and at treatment resistance. Despite evidence of the effectiveness of psychosocial treatments, they are rarely implemented and future research needs to encompass not just the conditions and potentially effective interventions but also the barriers to evidence-based practice. The paper concludes with a ‘treatment resource appendix’ directed at American social workers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Depression and anxiety and the most common mental health problems of later life, but relatively little is known about their unique manifestation in older adults. Moreover, much of the growing body of research on psychosocial interventions for this population has yet to be translated into practice. This systematically conducted review covers meta-analyses of interventions for late-life depression and anxiety; and primary research literature on the effectiveness of cognitive-behavioural therapy, interpersonal therapy and reminiscence therapy. The review also looks at combined (pharmacological/psychosocial) treatments and other non-pharmacological approaches (e.g. exercise), and at treatment resistance. Despite evidence of the effectiveness of psychosocial treatments, they are rarely implemented and future research needs to encompass not just the conditions and potentially effective interventions but also the barriers to evidence-based practice. The paper concludes with a ‘treatment resource appendix’ directed at American social workers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
This book explores the multifaceted experience of suffering in old age. Older adults suffer from a variety of causes such as illness, loss, and life disappointment, to name a few. Suffering also occurs due to experiences related to one's gender, ethnic background, and religion. Although gerontological literature has equated suffering with depression, grief, pain and sadness, elders themselves distinguished suffering from these concepts and at the same time showed how they are linked. Narratives of suffering from community-dwelling elders are interpreted in this book, along with the personal meaning of suffering that lies within each narrative. Through individual cases offered in each chapter, the book shows how elders assimilate the emotional and spiritual fractiousness of suffering into a life already labouring under the 'work' of old age, and at a stage in life when personal resources are lessened and time seems to be running out. During interviews, elderly respondents expressed their suffering non-verbally as well as with words. Their languages of suffering, such as silence, gestures, cries and stories, and their definitions, portraits, and theories about suffering were varied and unique. They viewed suffering as eminently human and part of the life course as well as a political outrage that thrives in "isms" that continue to exist-ageism, classism, racism, and sexism. Elders' definitions of suffering as well as their perception of its value emerged from the uniqueness of their lives as well as the profundity of their experiences.
This book explores the multifaceted experience of suffering in old age. Older adults suffer from a variety of causes such as illness, loss, and life disappointment, to name a few. Suffering also occurs due to experiences related to one's gender, ethnic background, and religion. Although gerontological literature has equated suffering with depression, grief, pain and sadness, elders themselves distinguished suffering from these concepts and at the same time showed how they are linked. Narratives of suffering from community-dwelling elders are interpreted in this book, along with the personal meaning of suffering that lies within each narrative. Through individual cases offered in each chapter, the book shows how elders assimilate the emotional and spiritual fractiousness of suffering into a life already labouring under the 'work' of old age, and at a stage in life when personal resources are lessened and time seems to be running out. During interviews, elderly respondents expressed their suffering non-verbally as well as with words. Their languages of suffering, such as silence, gestures, cries and stories, and their definitions, portraits, and theories about suffering were varied and unique. They viewed suffering as eminently human and part of the life course as well as a political outrage that thrives in "isms" that continue to exist-ageism, classism, racism, and sexism. Elders' definitions of suffering as well as their perception of its value emerged from the uniqueness of their lives as well as the profundity of their experiences.
Subject terms:
literature reviews, older people, pain, religious beliefs, depression, ethnicity, grief;
Journal of Human Behavior in the Social Environment, 14(4), 2006, pp.31-52.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
The US Census 2000 shows that people aged 65 and older form 13% of the total population and this proportion is increasing. African-Americans form the largest non-Caucasian sub-group. Depression is a common consequence of stroke, but most research to date focuses on Caucasian Americans. This paper presents the results of a literature review that looks at the prevalence of stroke, hypertension, type-2 diabetes and obesity among African-Americans, as well as mortality rates, rates of depression and differential racial responses to some medications. In addition, the review covers racial differences in socioeconomic status, access to health care, and the effect of religious orientations and social support networks on the likelihood that older African-Americans will report and seek help for depressive symptoms. Further research into depression (including post-stroke depression) and suicide in this group is needed, and current geriatric depression scales need to be examined to ensure sensitivity and specificity in relation to the multi-cultural differences that influence physical and mental health status. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
The US Census 2000 shows that people aged 65 and older form 13% of the total population and this proportion is increasing. African-Americans form the largest non-Caucasian sub-group. Depression is a common consequence of stroke, but most research to date focuses on Caucasian Americans. This paper presents the results of a literature review that looks at the prevalence of stroke, hypertension, type-2 diabetes and obesity among African-Americans, as well as mortality rates, rates of depression and differential racial responses to some medications. In addition, the review covers racial differences in socioeconomic status, access to health care, and the effect of religious orientations and social support networks on the likelihood that older African-Americans will report and seek help for depressive symptoms. Further research into depression (including post-stroke depression) and suicide in this group is needed, and current geriatric depression scales need to be examined to ensure sensitivity and specificity in relation to the multi-cultural differences that influence physical and mental health status. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
literature reviews, older people, stroke, black and minority ethnic people, depression, ethnicity;