Accepted Manuscript Title: Managing depression in older age: psychological interventions Author: Pim Cuijpers Eirini Karyotaki Anne Margriet Pot Mijung Park Charles F. Reynolds III PII: DOI: Reference:
S0378-5122(14)00196-0 http://dx.doi.org/doi:10.1016/j.maturitas.2014.05.027 MAT 6191
To appear in:
Maturitas
Received date: Revised date: Accepted date:
28-4-2014 27-5-2014 28-5-2014
Please cite this article as: Cuijpers P, Karyotaki E, Pot AM, Park M, Reynolds III CF, Managing depression in older age: psychological interventions, Maturitas (2014), http://dx.doi.org/10.1016/j.maturitas.2014.05.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Managing depression in older age: psychological interventions
ip t
Pim Cuijpers 1,2§ Eirini Karyotaki 1,2 Mijung Park 5
us
Charles F. Reynolds III 6
cr
Anne Margriet Pot 1,2,3,4
Department of Clinical Psychology, VU University Amsterdam, The Netherlands
2
EMGO Institute for Health and Care Research, The Netherlands
3
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, The
M
an
1
Netherlands
School of Psychology, University of Queensland, Australia
5
University of Pittsburgh School of Nursing, United States
6
University of Pittsburgh Schools of Medicine and Graduate School of Public Health,
Ac ce p
United States
te
d
4
CFR was in part supported by NIMH grant P30MH90333
§
Corresponding author:
Pim Cuijpers, Ph.D., Professor of Clinical Psychology, Department of Clinical
Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands, tel. # 31 20 5988757, fax. # 31 20 5988758, email: [email protected]
Page 1 of 30
Abstract The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated metaanalysis of these studies. A total of 44 studies comparing psychotherapies to control
ip t
groups, other therapies or pharmacotherapy could be included. The overall effect size
indicating the difference between psychotherapy and control groups was g=0.64 (95%
cr
CI: 0.47~0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g=0.27; 95%CI 0.16~0.37). Specific types of
us
psychotherapies that were found to be effective included cognitive behavior therapy (g=0.45; 95% CI: 0.29~0.60), life review therapy (g=0.59; 95% CI: 0.36~0.82) and problem-solving therapy (g=0.46; 95% CI: 0.18~0.74). Treatment compared to waiting
an
list control groups resulted in larger effect sizes than treatments compared to care-asusual and other control groups (p 59
Comm
MDD
1. PST 2. Supportive 1. PST 2. Supportive 1. PST 2. Supportive 1. PST 2. Life review 3. WL 1. OthTher 2. CAU 1. Life review 2. CAU 1. Tele- PST 2. PST 3. Telecare 1. CBT 2. CAU 1. CBT - gsh 2. CBT - ind 3. WL 1. Life rev - struct 2. Life rev - unstruct 3. Other control 1. CBT 2. BAT 3. DYN 1. Multicomponent 2. Waiting list 1. CBT 2. WL 1. CBT - ind 2. Supportive - ind 3. CBT - grp 4. Supportive – grp 1. CBT 2. WL 1. Coping ther 2. Supportive 3. OthCtr 1. CBT 2. CAU 1. PST 2. Supportive 1. Life review 2. CAU 1. CBT 2. CAU 1. CBT 2. CAU 1. CBT 2. WL 1. Dialect beh + PHA 2. PHA (protocol) 1. IPT 2. CAU 1. Life review
110 111 12 13 90 97 19 28 20 50 54 14 12 42 43 36 53 34 13 8 14 54 54 54 10 10 10 106 102 52 58 24 25 34 26 55 30 104 105 86 86 84 13 12 100 102 20 20 111 125 10 13 15 16 31 38 83
MDD
> 65
Comm
MDD
Arean, 1993
> 55
Comm
MDD
Burns, 2007
> 65
Other
Cut-off
Chan, 2013
> 60
Comm
Cut-off
Choi, 2013
> 50
Other
Cut-off
Ekkers, 2011
> 65
Clin
MDD
Floyd, 2004
> 60
Comm
Mood
Fry, 1983
6582
Other
Cut-off
Gallagher, 1982
> 55
Comm
MDD
Gitlin, 2013
> 55
Comm
Cut-off
Haringsma, 2005 Hautzinger, 2008
5585 > 65
Comm
Hautzinger, 2004 Heckman, 2011
> 60
Comm
Mood
> 50
Comm
Cut-off
Joling, 2011
> 75
Other
Cut-off
Kiosses, 2010
> 65
Comm
MDD
Korte, 2012
> 55
Comm
Cut-off
Laidlaw, 2008
> 60
Clin
MDD
Lamers, 2010
> 60
Other
Mood
Landreville, 1997 Lynch, 2003
> 55
Comm
Cut-off
> 60
Clin
MDD
Mossey, 1996
> 60
Other
Subclin
Pot, 2010
> 50
Comm
Subclin
te Cut-off
Ac ce p
Comm
Subclin
Nsess
Quality a)
12
−+++
Countr y US
Ind
12
−−++
US
Ind
12
++++
US
Grp
12
−−+−
US
Ind
6
++++
UK
Ind
5
+−++
Singap
Ind
6
−−−+
US
Grp
7
++++
NL
Gsh Ind
4 16
−−−−
US
Ind
5
−−+−
US
Ind
16
−−+−
US
Ind
10
++++
US
Grp
10
−−++
NL
Ind Ind Grp Grp Grp
15
−−++
GER
12
++++
GER
Grp
12
++++
US
Gsh
3
++++
NL
Ind
12
−−−+
US
Grp
8
++++
NL
Ind
8
+++−
UK
Ind
6
++++
NL
Gsh
4
−−+−
Canada
Grp
56
−−−−
US
Ind
10
−−+−
US
Grp
12
−+++
NL
an
Clin
M
> 65
d
Alexopoulos, 2011 Alexopoulos, 2003 Arean, 2010
Format Ind
ip t
Diagn
cr
Recr
us
Age
21 Page 21 of 30
2. OthCtr 88 1. Life review 20 Ind 8 +−++ Switz 2. WL 16 Reynolds, 1999 > 50 Comm MDD 1. IPT + PHA (TCA) 16 Ind 16 −−++ US 2. PHA 25 3. IPT + Placebo 17 4. Placebo 22 Scogin, 1987 > 60 Comm Cut-off 1. CBT 9 Gsh 4 −−−− US 2. WL 8 3. Attention-control 8 Scogin, 1989 > 60 Comm Cut-off 1. CBT – cwd 19 Gsh 4 −−−− US 2. CBT – ct 21 3. WL 21 Serfaty, 2009 > 65 Comm Mood 1. CBT 64 Ind 12 ++++ UK 2. Talking control 58 3. CAU 55 Serrano, 2004 65Other Cut-off 1. Life review 20 Ind 4 −−+− Spain 93 2. CAU 23 Serrano, 2012 64Clin MDD 1. Life review 9 Ind 6 −−++ Spain 83 2. Other control 8 Sirey, 2005 65Clin MDD 1. OthTher + PHA 21 Ind 5 −−++ US 85 2. PHA 24 Sloane, 1985 M= Other MDD 1. IPT 19 Ind 6 −−+− US 64.4 2. PHA 10 3. Placebo 14 Snarksi, 2011 > 65 Clin Cut-off 1. BAT 16 Ind 8 −−++ US 2. CAU 13 Spek, 2007 50Comm Subclin 1. CBT 102 Grp 10 ++++ NL 75 2. iCBT (unguided) 99 3. WL 100 Teri, 1997 M= Other Cut-off 1. PST 23 Ind 9 −−+− US 76.4 2. BAT 19 3. CAU 10 4. WL 20 Thompson, 1987 > 60 Comm MDD 1. CBT 14 Ind 18 −−−− US 2. BAT 6 3. DYN 9 Thompson, 1984 > 60 Other MDD 1. CBT 21 Ind 18 −−−− US 2. BAT 17 3. DYN 20 Thompson, 2001 > 60 Comm MDD 1. PHA (TCA) 33 Ind 18 −−−+ US 2. CBT 31 3. CBT + PHA 36 Van Schaik, > 55 Clin MDD 1. IPT 69 Ind 10 ++++ NL 2006 2. CAU 74 Watt, 2000 > 60 Comm Cut-off 1. Life rev – integr 9 Grp 6 −−+− Canada 2. Life rev – instr 9 3. Other control 9 Williams, 2000 > 60 Comm Mood 1. PHA (SSRI) 106 Ind 6 ++++ US 2. PST 113 3. Placebo 119 Wuthrich, 2013 > 60 Comm Cut-off 1. CBT 27 Grp 12 +−++ Austra2. Waiting list 35 lia a) In this column a positive (+), or negative (-) sign is given for four quality criteria, respectively: allocation sequence; concealment of allocation to conditions; blinding of assessors; and intention-to-treat analyses > 65
Comm
Cut-off
Ac ce p
te
d
M
an
us
cr
ip t
Preschl, 2012
Abbreviations: BAT: behavioral activation therapy; CAU: care-as-usual; CBT: cognitive behavior therapy; Clin: clinical; Comm: community; Cwd: Coping with Depression course; Diagn: diagnosis; Dialect beh: dialectic behavior therapy; DYN: psychodynamic therapy; GER: Germany; Grp: group; Gsh: guided self-help; iCBT: Internet-based CBT; Ind: individual; Instr: instrumental; Integr: integrated; IPT: interpersonal psychotherapy; Life rev: life review; MDD: major depressive disorder; Mood: mood disorder; NL: Netherlands; Nsess: number of sessions; OthCtr: Other control group; OthTher: other type of therapy; PHA: pharmacotherapy; PST: problem-solving therapy; Recr: recruitment;
22 Page 22 of 30
Ac ce p
te
d
M
an
us
cr
ip t
Singap: Singapore; Struct: structured; Switz: Switzerland; Ther: therapy; UK: United Kingdom; Unstruct: unstructured; US: United States; WL: waiting list.
23 Page 23 of 30
g 0.64 0.43 0.62 0.50 0.50 1.26 0.76 0.46
95% CI 0.47~0.80 0.33~0.52 0.43~0.80 0.33~0.67 0.33~0.67 0.86~1.65 0.26~1.26 0.29~0.62
I2 80 36 80 62 42 70 91 34
95% CI 73~85 4~58 72~85 44~74 0~66 47~83 87~94 0~72
NNT 2.86 4.20 2.96 3.62 3.62 1.59 2.44 3.91
Subgroup analysesd) Recruitment Community Clinical samples only Other Diagnosis Diagnosed mood dis. Cut-off selfreport Subclinical depression Psychotherapy CBT Life review PST Other Format f) Individual Group Guided self-help Number of 12-16 sessions 6-10 3-5 Control group Waiting list Care as usual Other Quality score 4 Lower than 4
20 5 10 14 17 4 14 7 5 9 18 11 6 8 19 8 13 13 9 12 23
0.49 0.27 0.36 0.42 0.47 0.36 0.45 0.59 0.46 0.29 0.36 0.50 0.47 0.48 0.36 0.61 0.60 0.38 0.28 0.34 0.52
0.36~0.61 -0.01~0.54 0.17~0.55 0.25~0.58 0.32~0.61 0.11~0.60 0.29~0.60 0.36~0.82 0.18~0.74 0.11~0.47 0.22~0.50 0.35~0.65 0.19~0.75 0.29~0.66 0.23~0.49 0.35~0.86 0.44~0.76 0.24~0.52 0.12~0.44 0.21~0.46 0.39~0.66
46 19 9 49 39 0 43 20 65 0 25 36 58 57 0 65 33 47 0 38 29
8~68 0~83 0~66 6~73 0~66 0~85 0~70 0~64 9~87 0~65 0~58 0~69 0~83 6~80 0~49 25~83 0~65 0~72 0~65 0~69 0~57
3.68 6.58 5.00 4.27 3.85 5.00 4.00 3.09 3.91 6.17 5.00 3.62 3.85 3.76 5.00 2.99 3.05 4.72 6.41 5.26 3.50
Direct comparisons g) - CBT vs other therapies - Behavioral activation vs other therapies - Psychodynamic vs other therapies - Problem solving ther. vs other therapies - Supportive counseling vs other therapies
8 6 6 6 6
0.31 0.06 -0.30 0.30 -0.34
0.05~0.57 -0.26~0.39 -0.63~0.03 0.08~0.52 -0.55~ -0.12
0 0 0 55 61
0~68 0~75 0~75 0~82 6~84
5.75 29.41 5.95 5.95 5.26
Comparisons with pharmacotherapy f) Combined versus pharmacotherapy Psychotherapy versus pharmacotherapy
4 3
0.41 -0.11
-0.05~0.88 -0.54~0.33
0 0
0~85 0~90
4.39 16.13
cr
us
M
d
te
Ac ce p
95% CI 2.34~3.85 3.50~5.43 2.34~4.20 2.75~4.10 2.75~4.10 1.32~2.19 1.59~6.85 2.96~6.17
p b)
2.99~5.00
0.26
ip t
All studies 5 possible outliers excluded c) One effect size per study (only highest) One effect size per study (only lowest) GDS only HAMD only BDI only CES-D only
Ncomp 40 35 32 32 19 13 12 7
an
Table 2. Effects of psychological treatments of depression in older adults compared with control groups: Hedges’ g a)
4.20 2.96 3.62
e)
3.31~10.42 3.14~7.14 2.99~5.56 3.05~16.13 3.05~6.17 2.28~5.00 2.50~9.80 3.85~16.13 3.62~8.06 2.82~5.10 2.48~9.43 2.78~6.17 3.68~7.69 2.19~5.10 2.44~4.10 3.50~7.46 4.10~14.71 3.91~8.47 2.78~4.59
0.73
0.24
0.41
0.19
0.02
0.05
3.18~35.71 e) e)
3.50~21.74 e)
e) e)
*: p
S0378-5122(14)00196-0 http://dx.doi.org/doi:10.1016/j.maturitas.2014.05.027 MAT 6191
To appear in:
Maturitas
Received date: Revised date: Accepted date:
28-4-2014 27-5-2014 28-5-2014
Please cite this article as: Cuijpers P, Karyotaki E, Pot AM, Park M, Reynolds III CF, Managing depression in older age: psychological interventions, Maturitas (2014), http://dx.doi.org/10.1016/j.maturitas.2014.05.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Managing depression in older age: psychological interventions
ip t
Pim Cuijpers 1,2§ Eirini Karyotaki 1,2 Mijung Park 5
us
Charles F. Reynolds III 6
cr
Anne Margriet Pot 1,2,3,4
Department of Clinical Psychology, VU University Amsterdam, The Netherlands
2
EMGO Institute for Health and Care Research, The Netherlands
3
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, The
M
an
1
Netherlands
School of Psychology, University of Queensland, Australia
5
University of Pittsburgh School of Nursing, United States
6
University of Pittsburgh Schools of Medicine and Graduate School of Public Health,
Ac ce p
United States
te
d
4
CFR was in part supported by NIMH grant P30MH90333
§
Corresponding author:
Pim Cuijpers, Ph.D., Professor of Clinical Psychology, Department of Clinical
Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands, tel. # 31 20 5988757, fax. # 31 20 5988758, email: [email protected]
Page 1 of 30
Abstract The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated metaanalysis of these studies. A total of 44 studies comparing psychotherapies to control
ip t
groups, other therapies or pharmacotherapy could be included. The overall effect size
indicating the difference between psychotherapy and control groups was g=0.64 (95%
cr
CI: 0.47~0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g=0.27; 95%CI 0.16~0.37). Specific types of
us
psychotherapies that were found to be effective included cognitive behavior therapy (g=0.45; 95% CI: 0.29~0.60), life review therapy (g=0.59; 95% CI: 0.36~0.82) and problem-solving therapy (g=0.46; 95% CI: 0.18~0.74). Treatment compared to waiting
an
list control groups resulted in larger effect sizes than treatments compared to care-asusual and other control groups (p 59
Comm
MDD
1. PST 2. Supportive 1. PST 2. Supportive 1. PST 2. Supportive 1. PST 2. Life review 3. WL 1. OthTher 2. CAU 1. Life review 2. CAU 1. Tele- PST 2. PST 3. Telecare 1. CBT 2. CAU 1. CBT - gsh 2. CBT - ind 3. WL 1. Life rev - struct 2. Life rev - unstruct 3. Other control 1. CBT 2. BAT 3. DYN 1. Multicomponent 2. Waiting list 1. CBT 2. WL 1. CBT - ind 2. Supportive - ind 3. CBT - grp 4. Supportive – grp 1. CBT 2. WL 1. Coping ther 2. Supportive 3. OthCtr 1. CBT 2. CAU 1. PST 2. Supportive 1. Life review 2. CAU 1. CBT 2. CAU 1. CBT 2. CAU 1. CBT 2. WL 1. Dialect beh + PHA 2. PHA (protocol) 1. IPT 2. CAU 1. Life review
110 111 12 13 90 97 19 28 20 50 54 14 12 42 43 36 53 34 13 8 14 54 54 54 10 10 10 106 102 52 58 24 25 34 26 55 30 104 105 86 86 84 13 12 100 102 20 20 111 125 10 13 15 16 31 38 83
MDD
> 65
Comm
MDD
Arean, 1993
> 55
Comm
MDD
Burns, 2007
> 65
Other
Cut-off
Chan, 2013
> 60
Comm
Cut-off
Choi, 2013
> 50
Other
Cut-off
Ekkers, 2011
> 65
Clin
MDD
Floyd, 2004
> 60
Comm
Mood
Fry, 1983
6582
Other
Cut-off
Gallagher, 1982
> 55
Comm
MDD
Gitlin, 2013
> 55
Comm
Cut-off
Haringsma, 2005 Hautzinger, 2008
5585 > 65
Comm
Hautzinger, 2004 Heckman, 2011
> 60
Comm
Mood
> 50
Comm
Cut-off
Joling, 2011
> 75
Other
Cut-off
Kiosses, 2010
> 65
Comm
MDD
Korte, 2012
> 55
Comm
Cut-off
Laidlaw, 2008
> 60
Clin
MDD
Lamers, 2010
> 60
Other
Mood
Landreville, 1997 Lynch, 2003
> 55
Comm
Cut-off
> 60
Clin
MDD
Mossey, 1996
> 60
Other
Subclin
Pot, 2010
> 50
Comm
Subclin
te Cut-off
Ac ce p
Comm
Subclin
Nsess
Quality a)
12
−+++
Countr y US
Ind
12
−−++
US
Ind
12
++++
US
Grp
12
−−+−
US
Ind
6
++++
UK
Ind
5
+−++
Singap
Ind
6
−−−+
US
Grp
7
++++
NL
Gsh Ind
4 16
−−−−
US
Ind
5
−−+−
US
Ind
16
−−+−
US
Ind
10
++++
US
Grp
10
−−++
NL
Ind Ind Grp Grp Grp
15
−−++
GER
12
++++
GER
Grp
12
++++
US
Gsh
3
++++
NL
Ind
12
−−−+
US
Grp
8
++++
NL
Ind
8
+++−
UK
Ind
6
++++
NL
Gsh
4
−−+−
Canada
Grp
56
−−−−
US
Ind
10
−−+−
US
Grp
12
−+++
NL
an
Clin
M
> 65
d
Alexopoulos, 2011 Alexopoulos, 2003 Arean, 2010
Format Ind
ip t
Diagn
cr
Recr
us
Age
21 Page 21 of 30
2. OthCtr 88 1. Life review 20 Ind 8 +−++ Switz 2. WL 16 Reynolds, 1999 > 50 Comm MDD 1. IPT + PHA (TCA) 16 Ind 16 −−++ US 2. PHA 25 3. IPT + Placebo 17 4. Placebo 22 Scogin, 1987 > 60 Comm Cut-off 1. CBT 9 Gsh 4 −−−− US 2. WL 8 3. Attention-control 8 Scogin, 1989 > 60 Comm Cut-off 1. CBT – cwd 19 Gsh 4 −−−− US 2. CBT – ct 21 3. WL 21 Serfaty, 2009 > 65 Comm Mood 1. CBT 64 Ind 12 ++++ UK 2. Talking control 58 3. CAU 55 Serrano, 2004 65Other Cut-off 1. Life review 20 Ind 4 −−+− Spain 93 2. CAU 23 Serrano, 2012 64Clin MDD 1. Life review 9 Ind 6 −−++ Spain 83 2. Other control 8 Sirey, 2005 65Clin MDD 1. OthTher + PHA 21 Ind 5 −−++ US 85 2. PHA 24 Sloane, 1985 M= Other MDD 1. IPT 19 Ind 6 −−+− US 64.4 2. PHA 10 3. Placebo 14 Snarksi, 2011 > 65 Clin Cut-off 1. BAT 16 Ind 8 −−++ US 2. CAU 13 Spek, 2007 50Comm Subclin 1. CBT 102 Grp 10 ++++ NL 75 2. iCBT (unguided) 99 3. WL 100 Teri, 1997 M= Other Cut-off 1. PST 23 Ind 9 −−+− US 76.4 2. BAT 19 3. CAU 10 4. WL 20 Thompson, 1987 > 60 Comm MDD 1. CBT 14 Ind 18 −−−− US 2. BAT 6 3. DYN 9 Thompson, 1984 > 60 Other MDD 1. CBT 21 Ind 18 −−−− US 2. BAT 17 3. DYN 20 Thompson, 2001 > 60 Comm MDD 1. PHA (TCA) 33 Ind 18 −−−+ US 2. CBT 31 3. CBT + PHA 36 Van Schaik, > 55 Clin MDD 1. IPT 69 Ind 10 ++++ NL 2006 2. CAU 74 Watt, 2000 > 60 Comm Cut-off 1. Life rev – integr 9 Grp 6 −−+− Canada 2. Life rev – instr 9 3. Other control 9 Williams, 2000 > 60 Comm Mood 1. PHA (SSRI) 106 Ind 6 ++++ US 2. PST 113 3. Placebo 119 Wuthrich, 2013 > 60 Comm Cut-off 1. CBT 27 Grp 12 +−++ Austra2. Waiting list 35 lia a) In this column a positive (+), or negative (-) sign is given for four quality criteria, respectively: allocation sequence; concealment of allocation to conditions; blinding of assessors; and intention-to-treat analyses > 65
Comm
Cut-off
Ac ce p
te
d
M
an
us
cr
ip t
Preschl, 2012
Abbreviations: BAT: behavioral activation therapy; CAU: care-as-usual; CBT: cognitive behavior therapy; Clin: clinical; Comm: community; Cwd: Coping with Depression course; Diagn: diagnosis; Dialect beh: dialectic behavior therapy; DYN: psychodynamic therapy; GER: Germany; Grp: group; Gsh: guided self-help; iCBT: Internet-based CBT; Ind: individual; Instr: instrumental; Integr: integrated; IPT: interpersonal psychotherapy; Life rev: life review; MDD: major depressive disorder; Mood: mood disorder; NL: Netherlands; Nsess: number of sessions; OthCtr: Other control group; OthTher: other type of therapy; PHA: pharmacotherapy; PST: problem-solving therapy; Recr: recruitment;
22 Page 22 of 30
Ac ce p
te
d
M
an
us
cr
ip t
Singap: Singapore; Struct: structured; Switz: Switzerland; Ther: therapy; UK: United Kingdom; Unstruct: unstructured; US: United States; WL: waiting list.
23 Page 23 of 30
g 0.64 0.43 0.62 0.50 0.50 1.26 0.76 0.46
95% CI 0.47~0.80 0.33~0.52 0.43~0.80 0.33~0.67 0.33~0.67 0.86~1.65 0.26~1.26 0.29~0.62
I2 80 36 80 62 42 70 91 34
95% CI 73~85 4~58 72~85 44~74 0~66 47~83 87~94 0~72
NNT 2.86 4.20 2.96 3.62 3.62 1.59 2.44 3.91
Subgroup analysesd) Recruitment Community Clinical samples only Other Diagnosis Diagnosed mood dis. Cut-off selfreport Subclinical depression Psychotherapy CBT Life review PST Other Format f) Individual Group Guided self-help Number of 12-16 sessions 6-10 3-5 Control group Waiting list Care as usual Other Quality score 4 Lower than 4
20 5 10 14 17 4 14 7 5 9 18 11 6 8 19 8 13 13 9 12 23
0.49 0.27 0.36 0.42 0.47 0.36 0.45 0.59 0.46 0.29 0.36 0.50 0.47 0.48 0.36 0.61 0.60 0.38 0.28 0.34 0.52
0.36~0.61 -0.01~0.54 0.17~0.55 0.25~0.58 0.32~0.61 0.11~0.60 0.29~0.60 0.36~0.82 0.18~0.74 0.11~0.47 0.22~0.50 0.35~0.65 0.19~0.75 0.29~0.66 0.23~0.49 0.35~0.86 0.44~0.76 0.24~0.52 0.12~0.44 0.21~0.46 0.39~0.66
46 19 9 49 39 0 43 20 65 0 25 36 58 57 0 65 33 47 0 38 29
8~68 0~83 0~66 6~73 0~66 0~85 0~70 0~64 9~87 0~65 0~58 0~69 0~83 6~80 0~49 25~83 0~65 0~72 0~65 0~69 0~57
3.68 6.58 5.00 4.27 3.85 5.00 4.00 3.09 3.91 6.17 5.00 3.62 3.85 3.76 5.00 2.99 3.05 4.72 6.41 5.26 3.50
Direct comparisons g) - CBT vs other therapies - Behavioral activation vs other therapies - Psychodynamic vs other therapies - Problem solving ther. vs other therapies - Supportive counseling vs other therapies
8 6 6 6 6
0.31 0.06 -0.30 0.30 -0.34
0.05~0.57 -0.26~0.39 -0.63~0.03 0.08~0.52 -0.55~ -0.12
0 0 0 55 61
0~68 0~75 0~75 0~82 6~84
5.75 29.41 5.95 5.95 5.26
Comparisons with pharmacotherapy f) Combined versus pharmacotherapy Psychotherapy versus pharmacotherapy
4 3
0.41 -0.11
-0.05~0.88 -0.54~0.33
0 0
0~85 0~90
4.39 16.13
cr
us
M
d
te
Ac ce p
95% CI 2.34~3.85 3.50~5.43 2.34~4.20 2.75~4.10 2.75~4.10 1.32~2.19 1.59~6.85 2.96~6.17
p b)
2.99~5.00
0.26
ip t
All studies 5 possible outliers excluded c) One effect size per study (only highest) One effect size per study (only lowest) GDS only HAMD only BDI only CES-D only
Ncomp 40 35 32 32 19 13 12 7
an
Table 2. Effects of psychological treatments of depression in older adults compared with control groups: Hedges’ g a)
4.20 2.96 3.62
e)
3.31~10.42 3.14~7.14 2.99~5.56 3.05~16.13 3.05~6.17 2.28~5.00 2.50~9.80 3.85~16.13 3.62~8.06 2.82~5.10 2.48~9.43 2.78~6.17 3.68~7.69 2.19~5.10 2.44~4.10 3.50~7.46 4.10~14.71 3.91~8.47 2.78~4.59
0.73
0.24
0.41
0.19
0.02
0.05
3.18~35.71 e) e)
3.50~21.74 e)
e) e)
*: p
