Short- and long-term efficacy of psychological intervention for depression in older adults

Objective: There is still a lack of controlled studies regarding the efficacy of psychotherapy with depressed older adults. In particular, the impact of specific intervention elements, the influence of setting variables, and the role of mild cognitive deficits on outcome are unknown. Goals: To investigate short- and long-term outcome of a specific cognitive-behavioural intervention for depression in older age (DiA) in comparison with a supportive non-specific intervention (UT), delivered either in an individual or a group setting. In addition, the influence of mild cognitive deficits and antidepressive medication on outcome of psychotherapy will be studied. Method: One hundred nine older adults with depression (with or without mild cognitive deficits) were randomized into one of four interventions: DiA-Individual, DiA-Group, UT-Individual, UT-Group. Outome was assessed by self- and clinician ratings before the 15-session interventions, at the end, and after one year follow-up. Results: As expected, all interventions reduced depressive symptoms. This reduction was still highly significant one year after termination of the interventions. Contrary to expectations, a specific cognitive-behavioural intervention had no more effects than a supportive non-specific psychotherapy. Neither group- or individual setting, taking or not taking antidepressants nor mild cognitive deficits did influence outcome. Conclusion: Psychotherapy with older adults suffering from depression, with or without mild cognitive deficits, works and leads to long-term positive outcome (d = 0,64 to 1,1). But these statistically significant and clinically relevant effects are more the results of non-specific supportive, counselling, psychoeducational elements of psychotherapy.