Intervention Review

Psychotherapeutic treatments for older depressed people

  1. Kenneth Wilson1,*,
  2. Patricia G Mottram2,
  3. Christopher Vassilas3

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 4 NOV 2007

DOI: 10.1002/14651858.CD004853.pub2


How to Cite

Wilson K, Mottram PG, Vassilas C. Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004853. DOI: 10.1002/14651858.CD004853.pub2.

Author Information

  1. 1

    Birkenhead, Wirral, UK

  2. 2

    University of Liverpool, Department of Psychiatry, Church Road, Birkenhead, UK

  3. 3

    Liverpool, UK

*Kenneth Wilson, Psychiatry, EMI Academic Unit, Univ of Liverpool, St Catherine's Hospital, Church Road, Birkenhead, Wirral, L42 0LQ, UK. kw500505@liverpool.ac.uk. kw500505@liverpool.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Despite a number of reviews advocating psychotherapy for the treatment of depression, there is relatively little evidence based on randomised controlled trials that specifically examines its efficacy in older people.

Objectives

To examine the efficacy of psychotherapeutic treatments for depression in older people.

Search methods

CCDANCTR-Studies and CCDANCTR-References were searched on 11/9/2006. The International Journal of Geriatric Psychiatry and Irish Journal of Psychiatry were handsearched. Reference lists of previous published systematic reviews, included/excluded trial articles and bibliographies were scrutinised.Experts in the field were contacted..

Selection criteria

All randomised controlled trials that included older adults diagnosed as suffering from depression (ICD or DSM criteria) were included. All types of psychotherapeutic treatments were included, categorised into cognitive behavioural therapies (CBT), psychodynamic therapy, interpersonal therapy and supportive therapies.

Data collection and analysis

Meta-analysis was performed, using odds ratios for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95% confidence intervals. Primary outcomes were a reduction in severity of depression, usually measured by clinician rated rating scales. Secondary outcomes, including dropout and life satisfaction, were also analysed.

Main results

The search identified nine trials of cognitive behavioural and psychodynamic therapy approaches, together with a small group of 'active control' interventions. No trials relating to other psychotherapeutic approaches and techniques were found. A total of seven trials provided sufficient data for inclusion in the comparison between CBT and controls. No trials compared psychodynamic psychotherapy with controls. Based on five trials (153 participants), cognitive behavioural therapy was more effective than waiting list controls (WMD -9.85, 95% CI -11.97 to -7.73). Only three small trials compared psychodynamic therapy with CBT, with no significant difference in treatment effect indicated between the two types of psychotherapeutic treatment. Based on three trials with usable data, CBT was superior to active control interventions when using the Hamilton Depression Rating Scale (WMD -5.69, 95% CI -11.04 to -0.35), but equivalent when using the Geriatric Depression Scale (WMD -2.00, 95% CI -5.31 to 1.32).

Authors' conclusions

Only a small number of studies and patients were included in the meta-analysis. If taken on their own merit, the findings do not provide strong support for psychotherapeutic treatments in the management of depression in older people. However, the findings do reflect those of a larger meta-analysis that included patients with broader age ranges, suggesting that CBT may be of potential benefit.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychotherapeutic treatments for older depressed people

Depression is a common problem facing older people and is often associated with loneliness, physical illness and pain. The condition can last for some years and causes considerable distress and illness. A significant majority of depressed elders do not receive treatment because of difficulty in recognition of the condition. Not only can it present with lowered mood but may also present with physical problems including sleep disturbance, loss of appetite, loss of interest, anxiety and lack of energy. Psychotherapy is recognised as a treatment for mild depression. In this review we included seven small trials, involving a total of 153 participants, that examined psychotherapeutic treatments for depression in older people. Five trials compared a form of cognitive behavioural therapy (CBT) against control conditions, and the findings showed that CBT was more effective than control. Two individual trials compared CBT against psychodynamic therapy, with no significant difference in effectiveness indicated between the two approaches. Our review shows that there is relatively little research in this field and care must be taken in generalising what evidence there is to clinical populations.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於老年憂鬱症患者的心理治療處遇

儘管許多文獻倡導使用心理治療來治療憂鬱症的患者,但是只有相當少的證據是利用隨機對照組來驗證心理治療在老年患者的效果

目標

檢驗心理治療處遇對於老年憂鬱症患者的效果

搜尋策略

搜尋CCDANCTRStudies 和CCDANCTRReferences 到11/9/2006。查詢The International Journal of Geriatric Psychiatry 和Irish Journal of Psychiatry 。查詢先前已發表的回顧文獻後的文獻表,查詢納入/排除文章和書目的文獻表。和這領域的專家接觸。

選擇標準

納入所有隨機對照試驗中',受試是老年人被診斷為憂鬱(ICD或DSM的診斷準則)的研究。納入所有形式的心理治療處遇,包括:認知行為治療(CBT)、精神分析治療、人際取向治療和支持性治療。

資料收集與分析

計算後設分析(Metaanalysis),對二分法變項計算勝算比,對連續性的變項計算加權均值的差異(WMD),使用95%的信賴區間。主要的結果測量為憂鬱嚴重度的下降率,由臨床者進行量表評估。同時也測量退出率和生活滿意度。

主要結論

確認出9篇的研究是有關認知行為治療和精神分析治療,和一組的主動控制組,沒有一個試驗和其他心理治療取向和技巧有關。在7篇試驗中提供足夠的資料來比較CBT和控制組,沒有一篇的試驗是比較精神分析和控制組。根據5篇的試驗中(包括153個受試),認知行為治療的效果比起等候名單的控制組更有效(WMD −9.85, 95% CI −11.97 to −7.73). 只有3篇是比較精神分析和CBT,在效果上並沒有顯著差異。根據3篇實用資料發現,CBT比起主動控制組在Hamilton Depression Rating Scale(WMD −5.69, 95% CI −11.04 to −0.35), 上表現較為優;若使用Geriatric Depression Scale 則相當(WMD −2.00, 95% CI −5.31 to 1.32).

作者結論

只有少數的研究及病人數納入後設分析。如果考慮它們的優點,結果並沒有提供很強的證據來支持心理治療處遇對於老年憂鬱症患者的效果。然而,這樣的結果反應出,如果能夠將年齡範圍加大進行後設分析,則可能會找到CBT潛在的好處.

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於老年憂鬱症患者的心理治療處遇憂鬱是老年人常面臨的問題,也通常和孤單、生病、疼痛有關。這種情況可能會持續很多年,而且引發嚴重的困擾和疾病。不只是因為低落的心情,有時會出現生理的問題,像睡眠困擾、沒有食慾、沒有興趣、焦慮、沒有精力。由於很難確認憂鬱的狀況,相當多的老年憂鬱症患者並沒有接受治療。心理治療被認為是治療輕度憂鬱症的一種方式。在這篇回顧文獻,納入7篇試驗,包括153名受試,來驗證心理治療處置在老年憂鬱症患者的效果。5篇的試驗比較認知行為治療(CBT)和控制組,結果顯示CBT比控制組有效。2個獨立試驗比較CBT和精神分析治療,發現在效果上兩個取向並無顯著的差異。此篇的文獻回顧顯示在這個領域中目前較少可信的研究,在照顧上也必須考慮由臨床上所得來的證據。