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Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial.
Arch Gen Psychiatry. 2009 Dec; 66(12):1332-40.AG

Abstract

CONTEXT

In older people, depressive symptoms are common, psychological adjustment to aging is complex, and associated chronic physical illness limits the use of antidepressants. Despite this, older people are rarely offered psychological interventions, and only 3 randomized controlled trials of individual cognitive behavioral therapy (CBT) in a primary care setting have been published.

OBJECTIVE

To determine the clinical effectiveness of CBT delivered in primary care for older people with depression.

DESIGN

A single-blind, randomized, controlled trial with 4- and 10-month follow-up visits.

PATIENTS

A total of 204 people aged 65 years or older (mean [SD] age, 74.1 [7.0] years; 79.4% female; 20.6% male) with a Geriatric Mental State diagnosis of depression were recruited from primary care.

INTERVENTIONS

Treatment as usual (TAU), TAU plus a talking control (TC), or TAU plus CBT. The TC and CBT were offered over 4 months.

OUTCOME MEASURES

Beck Depression Inventory-II (BDI-II) scores collected at baseline, end of therapy (4 months), and 10 months after the baseline visit. Subsidiary measures were the Beck Anxiety Inventory, Social Functioning Questionnaire, and Euroqol. Intent to treat using Generalized Estimating Equation and Compliance Average Causal Effect analyses were used.

RESULTS

Eighty percent of participants were followed up. The mean number of sessions of TC or CBT was just greater than 7. Intent-to-treat analysis found improvements of -3.07 (95% confidence interval [CI], -5.73 to -0.42) and -3.65 (95% CI, -6.18 to -1.12) in BDI-II scores in favor of CBT vs TAU and TC, respectively. Compliance Average Causal Effect analysis compared CBT with TC. A significant benefit of CBT of 0.4 points (95% CI, 0.01 to 0.72) on the BDI-II per therapy session was observed. The cognitive therapy scale showed no difference for nonspecific, but significant differences for specific factors in therapy. Ratings for CBT were high (mean [SD], 54.2 [4.1]).

CONCLUSION

Cognitive behavioral therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects.

TRIAL REGISTRATION

isrctn.org Identifier: ISRCTN18271323.

Authors+Show Affiliations

Department of Mental Health Sciences, University College Medical School, Rowland Hill St, London NW3 2PF, England. m.serfaty@medsch.ucl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19996038

Citation

Serfaty, Marc Antony, et al. "Clinical Effectiveness of Individual Cognitive Behavioral Therapy for Depressed Older People in Primary Care: a Randomized Controlled Trial." Archives of General Psychiatry, vol. 66, no. 12, 2009, pp. 1332-40.
Serfaty MA, Haworth D, Blanchard M, et al. Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. Arch Gen Psychiatry. 2009;66(12):1332-40.
Serfaty, M. A., Haworth, D., Blanchard, M., Buszewicz, M., Murad, S., & King, M. (2009). Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. Archives of General Psychiatry, 66(12), 1332-40. https://doi.org/10.1001/archgenpsychiatry.2009.165
Serfaty MA, et al. Clinical Effectiveness of Individual Cognitive Behavioral Therapy for Depressed Older People in Primary Care: a Randomized Controlled Trial. Arch Gen Psychiatry. 2009;66(12):1332-40. PubMed PMID: 19996038.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. AU - Serfaty,Marc Antony, AU - Haworth,Deborah, AU - Blanchard,Martin, AU - Buszewicz,Marta, AU - Murad,Shahed, AU - King,Michael, PY - 2009/12/10/entrez PY - 2009/12/10/pubmed PY - 2009/12/16/medline SP - 1332 EP - 40 JF - Archives of general psychiatry JO - Arch. Gen. Psychiatry VL - 66 IS - 12 N2 - CONTEXT: In older people, depressive symptoms are common, psychological adjustment to aging is complex, and associated chronic physical illness limits the use of antidepressants. Despite this, older people are rarely offered psychological interventions, and only 3 randomized controlled trials of individual cognitive behavioral therapy (CBT) in a primary care setting have been published. OBJECTIVE: To determine the clinical effectiveness of CBT delivered in primary care for older people with depression. DESIGN: A single-blind, randomized, controlled trial with 4- and 10-month follow-up visits. PATIENTS: A total of 204 people aged 65 years or older (mean [SD] age, 74.1 [7.0] years; 79.4% female; 20.6% male) with a Geriatric Mental State diagnosis of depression were recruited from primary care. INTERVENTIONS: Treatment as usual (TAU), TAU plus a talking control (TC), or TAU plus CBT. The TC and CBT were offered over 4 months. OUTCOME MEASURES: Beck Depression Inventory-II (BDI-II) scores collected at baseline, end of therapy (4 months), and 10 months after the baseline visit. Subsidiary measures were the Beck Anxiety Inventory, Social Functioning Questionnaire, and Euroqol. Intent to treat using Generalized Estimating Equation and Compliance Average Causal Effect analyses were used. RESULTS: Eighty percent of participants were followed up. The mean number of sessions of TC or CBT was just greater than 7. Intent-to-treat analysis found improvements of -3.07 (95% confidence interval [CI], -5.73 to -0.42) and -3.65 (95% CI, -6.18 to -1.12) in BDI-II scores in favor of CBT vs TAU and TC, respectively. Compliance Average Causal Effect analysis compared CBT with TC. A significant benefit of CBT of 0.4 points (95% CI, 0.01 to 0.72) on the BDI-II per therapy session was observed. The cognitive therapy scale showed no difference for nonspecific, but significant differences for specific factors in therapy. Ratings for CBT were high (mean [SD], 54.2 [4.1]). CONCLUSION: Cognitive behavioral therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN18271323. SN - 1538-3636 UR - https://www.unboundmedicine.com/medline/citation/19996038/Clinical_effectiveness_of_individual_cognitive_behavioral_therapy_for_depressed_older_people_in_primary_care:_a_randomized_controlled_trial_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=19996038.ui DB - PRIME DP - Unbound Medicine ER -