Comparison of the effectiveness of cognitive behavioral therapy for depression among older versus younger veterans: results of a national evaluation.
OBJECTIVE
The effectiveness of cognitive behavioral therapy for depression (CBT-D) among older adults in routine clinical settings has received limited attention. The current article examines and compares outcomes of older versus younger veterans receiving CBT-D nationally.


METHODS
Patient outcomes were assessed using the Beck Depression Inventory-II and World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed using the Working Alliance Inventory-Short Revised.


RESULTS
A total of 764 veterans aged 18-64 and 100 veterans aged 65+ received CBT-D; 68.0% of older and 68.3% of younger patients completed all sessions or finished early due to symptom relief, and mean depression scores declined from 27.0 (standard deviation [SD] = 10.7) to 16.2 (SD = 12.4) in the older group and from 29.1 (SD = 11.2) to 17.8 (SD = 13.5) in the younger group. Within-group effect sizes were d = 1.01 for both groups. Significant increases in quality of life and therapeutic alliance were observed for both groups.


CONCLUSIONS
CBT-D resulted in significant improvements in depression and quality of life among older patients. Outcomes and rate of attrition were equivalent to younger patients. Findings indicate that CBT-D is an effective and acceptable treatment for older veterans in real-world settings with often high levels of depression.
Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. Bradley.Karlin2@va.gov.
Bradley E
BE
Karlin
Department of Psychiatry, Stanford University Medical Center, Palo Alto, California. VISN 21 Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, California.
Mickey
M
Trockel
VISN 4 Mental Illness Research, Education and Clinical Center, Philadelphia VA Medical Center, Pennsylvania. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Gregory K
GK
Brown
Department of Psychiatry, Stanford University Medical Center, Palo Alto, California. VISN 21 Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, California.
Maria
M
Gordienko
Department of Psychiatry, Stanford University Medical Center, Palo Alto, California. VISN 21 Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, California.
Jerome
J
Yesavage
Department of Psychiatry, Stanford University Medical Center, Palo Alto, California. VISN 21 Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, California.
C Barr
CB
Taylor
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
Cognitive behavioral therapy; Department of Veterans Affairs; Depression; Geriatrics; Older adults; Veterans.