title: A systematic review and meta-analysis of psychotherapy for late-life depression.
abstract: OBJECTIVE
  To determine the efficacy of psychotherapy in late-life depression and to determine the effect of the type of control group on the magnitude of psychotherapy effects.
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled psychotherapy trials for late-life depression.
  
  
  METHODS
  Outpatient clinics or in subjects' home.
  
  
  METHODS
  Subjects aged 55 years or older with acute-phase depressive disorder.
  
  
  METHODS
  Change in depressive symptoms was measured with validated scales. Standardized mean differences (SMD) were calculated for each therapy-control contrast, as meta-analytic summaries for contrasts using a similar control, and for all contrasts combined.
  
  
  RESULTS
  The search identified 27 trials with 37 therapy-control contrasts and 2,245 subjects. Trials utilized five types of control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo). In the combined contrasts, psychotherapy was effective (SMD: 0.73; 95% confidence interval [CI]: 0.51, 0.95; z=6.42, p<0.00001). The SMD varied widely (from 0.05 to 1.36) and significantly (χ2=35.67, df=4, p<0.00001) between subgroups by type of control. In five trials that compared psychotherapy with supportive therapy, the SMD was 0.39 (95% CI: 0.16, 0.61; z=3.37, p<0.0007; I2=0%). The SMD was 0.11 within the waitlist controls and 1.10 within the supportive therapy subgroup.
  
  
  CONCLUSIONS
  Psychotherapy is effective for late-life depression, but the magnitude of the effect varies widely with the type of control group. Supportive therapy appears to best control for the nonspecific elements of psychotherapy and is associated with considerable change itself, but few trials have utilized it as a control.
authors.affiliation: University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA.
authors.forename: Alice X
authors.initials: AX
authors.lastname: Huang
authors.affiliation: University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Delucchi
authors.affiliation: University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA; University of California, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dunn
authors.affiliation: University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA. Electronic address: CraigN@lppi.ucsf.edu.
authors.forename: J Craig
authors.initials: JC
authors.lastname: Nelson
mesh_terms: D000375:Aging / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D000067562:Late Onset Disorders; D011613:Psychotherapy
keywords: Geriatric; late-life depression; meta-analysis; psychotherapy