Regular Research Article
A Systematic Review and Meta-analysis of Psychotherapy for Late-Life Depression

Presented in part at the American Psychiatric Association Annual Meeting 2013, San Francisco, May 20, 2013, and the American Association for Geriatric Psychiatry Annual Meeting 2013, Los Angeles, March 14, 2013.
https://doi.org/10.1016/j.jagp.2014.04.003Get rights and content

Objectives

To determine the efficacy of psychotherapy in late-life depression and to determine the effect of the type of control group on the magnitude of psychotherapy effects.

Design

A systematic review and meta-analysis of randomized controlled psychotherapy trials for late-life depression.

Setting

Outpatient clinics or in subjects' home.

Participants

Subjects aged 55 years or older with acute-phase depressive disorder.

Measurements

Change in depressive symptoms was measured with validated scales. Standardized mean differences (SMD) were calculated for each therapy-control contrast, as meta-analytic summaries for contrasts using a similar control, and for all contrasts combined.

Results

The search identified 27 trials with 37 therapy-control contrasts and 2,245 subjects. Trials utilized five types of control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo). In the combined contrasts, psychotherapy was effective (SMD: 0.73; 95% confidence interval [CI]: 0.51, 0.95; z = 6.42, p <0.00001). The SMD varied widely (from 0.05 to 1.36) and significantly (χ2 = 35.67, df = 4, p <0.00001) between subgroups by type of control. In five trials that compared psychotherapy with supportive therapy, the SMD was 0.39 (95% CI: 0.16, 0.61; z = 3.37, p <0.0007; I2 = 0%). The SMD was 0.11 within the waitlist controls and 1.10 within the supportive therapy subgroup.

Conclusions

Psychotherapy is effective for late-life depression, but the magnitude of the effect varies widely with the type of control group. Supportive therapy appears to best control for the nonspecific elements of psychotherapy and is associated with considerable change itself, but few trials have utilized it as a control.

Section snippets

Search Strategy

We searched electronic databases PubMed (MESH and text), PsycInfo (title, keywords, and text), and Cochrane Central Register of Controlled Trials (MESH, keywords, title, abstract) on May 11, 2012. We used terms for the intervention (psychotherapy, counseling, therapy), the older adult population (aged, aging, elder, elderly, geriatric, late life, later life, old, older), and depression symptomatology (depressed, depression, depressive disorder). We limited the search to published, English

Characteristics of Included Studies

Our search yielded 2,706 potential articles (Fig. 1). Review of key articles, reviews, and the online psychotherapy database produced another 64 articles. We excluded 2,628 articles based on abstract, and reviewed the remaining 142 full articles. There were 13 articles cited in other reviews that were excluded because they did not meet our inclusion criteria (see Supplemental Digital Content 2, which describes these excluded trials; available online).

A total of 27 trials conducted between 1981

Conclusions

Our meta-analysis confirmed previous findings that psychotherapy is an effective treatment for depression in late life.4, 5, 6, 7 As hypothesized, the magnitude of the effect varied significantly by the type of control group. Furthermore, the effect of type of control on the SMD was relatively large compared with other factors (Table 2). Psychotherapy interventions yielded large effects when compared with waitlist and attention controls but small to moderate effects when compared with

References (48)

  • B.R. Rutherford et al.

    Contribution of spontaneous improvement to placebo response in depression: a meta-analytic review

    J Psychiatr Res

    (2012)
  • B.R. Rutherford et al.

    Clinic visits in late life depression trials: effects on signal detection and therapeutic outcome

    Am J Geriatr Psychiatry

    (2014)
  • J. Snowdon et al.

    The diagnosis and treatment of unipolar depression in late life

  • M. Pinquart et al.

    How effective are psychotherapeutic and other psychosocial interventions in older adults? A meta-analysis

    J Ment Health Aging

    (2001)
  • P. Cuijpers et al.

    Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials

    Int J Geriatr Psychiatry

    (2006)
  • M. Pinquart et al.

    Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy

    Am J Psychiatry

    (2006)
  • K. Wilson et al.

    Psychotherapeutic treatments for older depressed people

    Cochrane Database of Systematic Reviews

    (2008)
  • T.W. Baskin et al.

    Establishing specificity in psychotherapy: a meta-analysis of structural equivalence of placebo controls

    J Consult Clin Psychol

    (2003)
  • Barth J, Munder T, Gerger H, et al: Comparative efficacy of seven psychotherapeutic interventions for patients with...
  • B.E. Wampold

    The great psychotherapy debate: models, methods, and findings

    (2001)
  • Psychotherapy: randomized controlled and comparative trials [database online]. Amsterdam, Vrije Universiteit Amsterdam,...
  • Higgins JPT, Deeks JJ, Altman DG: Chapter 16: Special topics in statistics, in Cochrane Handbook for Systematic Reviews...
  • J.C. Nelson et al.

    Moderators of outcome in late-life depression: a patient-level meta-analysis

    Am J Psychiatry

    (2013)
  • M. Egger et al.

    Bias in meta-analysis detected by a simple, graphical test

    BMJ

    (1997)
  • Cited by (86)

    • Geriatric Depression

      2023, Primary Care - Clinics in Office Practice
    • Treatment resistant depression in elderly

      2023, Progress in Brain Research
    View all citing articles on Scopus

    Supplemental digital content is available for this article in the HTML and PDF versions of this article on the journal's Web site (www.ajgponline.org).

    View full text