title: Psychological Treatment of Depression in People Aged 65 Years and Over: A Systematic Review of Efficacy, Safety, and Cost-Effectiveness.
abstract: OBJECTIVE
  Depression in elderly people is a major public health concern. As response to antidepressants is often unsatisfactory in this age group, there is a need for evidence-based non-pharmacological treatment options. Our objectives were twofold: firstly, to synthesize published trials evaluating efficacy, safety and cost-effectiveness of psychological treatment of depression in the elderly and secondly, to assess the quality of evidence.
  
  
  METHODS
  The electronic databases PubMed, EMBASE, Cochrane Library, CINAL, Scopus, and PsycINFO were searched up to 23 May 2016 for randomized controlled trials (RCTs) of psychological treatment for depressive disorders or depressive symptoms in people aged 65 years and over. Two reviewers independently assessed relevant studies for risk of bias. Where appropriate, the results were synthesized in meta-analyses. The quality of the evidence was graded according to GRADE (Grading of Recommendations Assessment, Development and Evaluation).
  
  
  RESULTS
  Twenty-two relevant RCTs were identified, eight of which were excluded from the synthesis due to a high risk of bias. Of the remaining trials, six evaluated problem-solving therapy (PST), five evaluated other forms of cognitive behavioural therapy (CBT), and three evaluated life review/reminiscence therapy. In frail elderly with depressive symptoms, the evidence supported the efficacy of PST, with large but heterogeneous effect sizes compared with treatment as usual. The results for life-review/reminiscence therapy and CBT were also promising, but because of the limited number of trials the quality of evidence was rated as very low. Safety data were not reported in any included trial. The only identified cost-effectiveness study estimated an incremental cost per additional point reduction in Beck Depression Inventory II score for CBT compared with talking control and treatment as usual.
  
  
  CONCLUSIONS
  Psychological treatment is a feasible option for frail elderly with depressive symptoms. However, important questions about efficacy, generalizability, safety and cost-effectiveness remain.
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.|Department of Neuroscience, Child and adolescent psychiatry, Uppsala University, Uppsala, Sweden.|National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Jonsson
authors.affiliation: Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Bertilsson
authors.affiliation: Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Allard
authors.affiliation: Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.|Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Harald
authors.initials: H
authors.lastname: Gyllensvärd
authors.affiliation: School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, Mälardalen, Våsterås, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Söderlund
authors.affiliation: Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Tham
authors.affiliation: Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.|Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy / Q000191:economics / Q000379:methods*