title: Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability.
abstract: BACKGROUND
  Older patients with depression and executive dysfunction represent a population with significant disability and a high likelihood of failing pharmacotherapy.
  
  
  OBJECTIVE
  To examine whether problem-solving therapy (PST) reduces disability more than does supportive therapy (ST) in older patients with depression and executive dysfunction and whether this effect is mediated by improvement in depressive symptoms.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Weill Cornell Medical College and University of California at San Francisco.
  
  
  METHODS
  Adults (aged >59 years) with major depression and executive dysfunction recruited between December 2002 and November 2007 and followed up for 36 weeks. Intervention Twelve sessions of PST modified for older depressed adults with executive impairment or ST. Main Outcome Measure Disability as quantified using the 12-item World Health Organization Disability Assessment Schedule II.
  
  
  RESULTS
  Of 653 individuals referred to this study, 221 met the inclusion criteria and were randomized to receive PST or ST. Both PST and ST led to comparable improvement in disability in the first 6 weeks of treatment, but a more prominent reduction was noted in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and more previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was, in part, due to greater reduction in disability by PST. Although disability increased during the 24 weeks after the end of treatment, the advantage of PST over ST was retained.
  
  
  CONCLUSIONS
  These results suggest that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00052091.
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA. gsalexop@med.cornell.edu
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.forename: R Scott
authors.initials: RS
authors.lastname: Mackin
authors.forename: Dora
authors.initials: D
authors.lastname: Kanellopoulos
authors.forename: Charles
authors.initials: C
authors.lastname: McCulloch
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Areán
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009629:Person-Centered Psychotherapy / Q000379:methods*; D011340:Problem Solving; D011613:Psychotherapy / Q000379:methods; D012944:Social Support; D016896:Treatment Outcome