Depression and Suicidal Ideation During Two Psychosocial Treatments in Older Adults with Major Depression and Dementia

Abstract

Background Depression is prevalent in dementia and contributes to poor outcomes for patients and their families. Antidepressants have limited efficacy in older adults with major depression and dementia and psychosocial interventions are under-investigated. Objective To examine the course and predictors of depression and suicidal ideation during 12 weeks of home-delivered Problem Adaptation Therapy (PATH) vs. Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in 39 older adults with major depression and dementia. Methods Thirty-nine older adults with major depression, mild or moderate dementia, and disability participated in an RCT that compared the efficacy of PATH versus ST-CI. Depression and suicidal ideation were assessed with Cornell Scale for Depression in Dementia (CSDD) Total Score and Suicide Item. Results PATH participants had significantly greater reduction in depression than ST-CI participants over 12 weeks of treatment. PATH participants with high social support had the greatest reduction in depression. Both treatments had comparable reduction in suicidal ideation. Conclusion PATH is more effective in reducing depression in older adults with major depression and dementia compared to ST-CI. These results are clinically significant as antidepressant medication treatments have limited efficacy in this population. Home-delivered psychosocial treatments may reduce suicidal ideation in this population.

Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis

“…Depression Of 14 studies investigating depression, 6 studies evaluating carecoordination interventions (n = 3314) 33,45,47,48,55,60 and 2 studies of cognitive-behavioural interventions 43,44 (n = 400) significantly reduced depressive symptoms in patients with [depression + another disease (COPD, 33,44 arthritis, 55 dementia 43,47 or DM 44,60 )]; and for patients with [DM + CVD] 48 (p value range < 0.001 to 0.021). The other studies did not report effect sizes.…”

Effectiveness of counselling and psychotherapeutic interventions for people with dementia and their families: a systematic review

“…Five studies from the same research group compared face-to-face PATH to face-to-face Supportive Therapy (ST) (Kiosses et al, 2010(Kiosses et al, , 2011(Kiosses et al, , 2015a(Kiosses et al, , 2015b(Kiosses et al, , 2017. PATH aims to reduce depression and disability by facilitating problem solving and adaptive functioning, utilising tools to circumvent the behavioural and functional limitations exacerbated by cognitive impairment (e.g.…”

Advances in Psychotherapy for Depressed Older Adults

“…To achieve emotion regulation, PATH uses PST as a basic framework and incorporates environmental adaptations such as cues, reminders, timers, and step-by-step breakdown of tasks; PATH also encourages family or caregiver participation to assist in problem solving efforts and task completion. In an RCT, PATH reduced depression severity and disability in comparison to supportive psychotherapy for the entire sample [49], and reduced depression severity for the subgroup of patients with mild to moderate dementia [50]. …”

“…While major depression is the most common condition associated with suicide, other risk factors include suicidal ideation, medical illness, functional impairment, stressful life events, and substance abuse [52]. A number of interventions and psychotherapies have been shown to reduce suicidal ideation among older adults [50, 53–56], and Cognitive Behavioral Therapy for the prevention of suicide has been shown to be effective for younger and mid-life adults who have made suicide attempts [57]. Recent work suggests that different psychotherapies may be appropriate for different intensities of suicidal ideation.…”