Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial.
BACKGROUND
In older people, depressive symptoms are common, psychological adjustment to aging is complex, and associated chronic physical illness limits the use of antidepressants. Despite this, older people are rarely offered psychological interventions, and only 3 randomized controlled trials of individual cognitive behavioral therapy (CBT) in a primary care setting have been published.


OBJECTIVE
To determine the clinical effectiveness of CBT delivered in primary care for older people with depression.


METHODS
A single-blind, randomized, controlled trial with 4- and 10-month follow-up visits.


METHODS
A total of 204 people aged 65 years or older (mean [SD] age, 74.1 [7.0] years; 79.4% female; 20.6% male) with a Geriatric Mental State diagnosis of depression were recruited from primary care.


METHODS
Treatment as usual (TAU), TAU plus a talking control (TC), or TAU plus CBT. The TC and CBT were offered over 4 months.


METHODS
Beck Depression Inventory-II (BDI-II) scores collected at baseline, end of therapy (4 months), and 10 months after the baseline visit. Subsidiary measures were the Beck Anxiety Inventory, Social Functioning Questionnaire, and Euroqol. Intent to treat using Generalized Estimating Equation and Compliance Average Causal Effect analyses were used.


RESULTS
Eighty percent of participants were followed up. The mean number of sessions of TC or CBT was just greater than 7. Intent-to-treat analysis found improvements of -3.07 (95% confidence interval [CI], -5.73 to -0.42) and -3.65 (95% CI, -6.18 to -1.12) in BDI-II scores in favor of CBT vs TAU and TC, respectively. Compliance Average Causal Effect analysis compared CBT with TC. A significant benefit of CBT of 0.4 points (95% CI, 0.01 to 0.72) on the BDI-II per therapy session was observed. The cognitive therapy scale showed no difference for nonspecific, but significant differences for specific factors in therapy. Ratings for CBT were high (mean [SD], 54.2 [4.1]).


CONCLUSIONS
Cognitive behavioral therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects.


BACKGROUND
isrctn.org Identifier: ISRCTN18271323.
Serfaty
Marc Antony
MA
Department of Mental Health Sciences, University College Medical School, Rowland Hill St, London NW3 2PF, England. m.serfaty@medsch.ucl.ac.uk
Haworth
Deborah
D
Blanchard
Martin
M
Buszewicz
Marta
M
Murad
Shahed
S
King
Michael
M
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010555:Personality Inventory; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000928:Antidepressive Agents