Older adults respond better to psychological therapy than working-age adults: evidence from a large sample of mental health service attendees

Rob Saunders, Joshua E J Buckman, Joshua Stott, Judy Leibowitz, Elisa Aguirre, Amber John, Glyn Lewis, John Cape, Stephen Pilling, NCEL network, Rob Saunders, Joshua E J Buckman, Joshua Stott, Judy Leibowitz, Elisa Aguirre, Amber John, Glyn Lewis, John Cape, Stephen Pilling, NCEL network

Abstract

Background: Older adults commonly experience depression and anxiety, yet are under-represented in psychological treatment services. There is uncertainty about the outcomes from psychological therapies for older adults relative to working-age adults. This study explored: pre-treatment differences between older and working-age patients with depression or anxiety disorders; whether outcomes from psychological therapy differ between groups controlling for pre-treatment clinical severity, functioning, and socio-demographics; and whether the impact of a long-term health condition (LTC) on outcome differs by age.

Methods: Data on >100,000 patients treated with psychological therapies in eight Improving Access to Psychological Therapies services were analyzed. We compared pre-treatment characteristics and therapy outcomes for older (≥65 years) and working-age (18-64 years) patients, and investigated associations between age and outcomes.

Results: Older adults had less severe clinical presentations pre-treatment. In adjusted models older adults were more likely to reliably recover (OR=1.33(95%CI=1.24-1.43)), reliably improve (OR=1.34(95%CI =1.24-1.45)), and attrition was less likely (OR=0.48(95%CI =0.43-0.53)). Effects were more pronounced in patients with anxiety disorders compared to depression. Having an LTC was associated with a much lower likelihood of reliable recovery for working-age patients but had only a modest effect for older adults.

Limitations: There are potential selection biases affecting the characteristics of older people attending these services. Residual confounding cannot be ruled out due to limits on data available.

Conclusions: Older adults experienced better outcomes from psychological treatments than working-age adults. Given the deleterious effects if mental health conditions go untreated, increasing access to psychological therapies for older people should be an international priority.

Keywords: Anxiety disorders; Community mental health services; Depressive disorder; Geriatric psychiatry; Psychological therapy; Psychotherapy outcome research.

Conflict of interest statement

None to declare.

Copyright © 2021. Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
Impact of LTC status on recovery between older and working-age patients.

References

    1. Amati F., Banks C., Greenfield G., Green J. Predictors of outcomes for patients with common mental health disorders receiving psychological therapies in community settings: a systematic review. J. Public Health (Bangkok). 2018;40:375–387. doi: 10.1093/pubmed/fdx168.
    1. Austin P.C. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav. Res. 2011;46:399–424. doi: 10.1080/00273171.2011.568786.
    1. Birdsey N. Integrating CBT and CFT within a case formulation approach to reduce depression and anxiety in an older adult with a complex mental and physical health history: a single case study. Cogn. Behav. Ther. 2020;13 doi: 10.1017/S1754470X20000410.
    1. Bodner E., Palgi Y., Wyman M.F. Contemporary Perspectives on Ageism. Springer; Cham: 2018. Ageism in mental health assessment and treatment of older adults; pp. 241–262.
    1. Buckman J.E.J., Saunders R., Cohen Z.D., Barnett P., Clarke K., Ambler G., DeRubeis R.J., Gilbody S., Hollon S.D., Kendrick T., Watkins E., Wiles N., Kessler D., Richards D., Sharp D., Brabyn S., Littlewood E., Salisbury C., White I.R., Lewis G., Pilling S. The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis. Psychol. Med. 2021:1–14. doi: 10.1017/S0033291721001367.
    1. Buckman J.E.J., Saunders R., Stott J., Arundell L.-L., O'Driscoll C., Davies M., Eley T.C., Hollon S.D., Kendrick T., Ambler G., Cohen Z.D., Watkins E.R., Gilbody S., Wiles N.J., Kessler D., Richards D., Brabyn S., Littlewood E., DeRubeis R.J., Lewis G., Pilling S. The role of Age, Gender, and Marital Status in prognosis for adults with depression: An Individual Patient Data Meta- analysis. Epidemiol. Psychiatr. Sci. 2021
    1. Buckman J.E.J., Underwood A., Clarke K., Saunders R., Hollon S.D., Fearon P., Pilling S. Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis. Clin. Psychol. Rev. 2018;64:13–38. doi: 10.1016/j.cpr.2018.07.005.
    1. Byers A.L., Yaffe K. Depression and risk of developing dementia. Nat. Rev. Neurol. 2011;7:323–331. doi: 10.1038/nrneurol.2011.60.
    1. Callahan C.M. Quality improvement research on late life depression in primary care. Med. Care. 2001;39:772–784. doi: 10.1097/00005650-200108000-00004.
    1. Carvalho A.F., Sharma M.S., Brunoni A.R., Vieta E., Fava G.A. The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: a critical review of the literature. Psychother. Psychosom. 2016;85:270–288. doi: 10.1159/000447034.
    1. Catarino A., Bateup S., Tablan V., Innes K., Freer S., Richards A., Stott R., Hollon S.D., Chamberlain S.R., Hayes A., Blackwell A.D. Demographic and clinical predictors of response to internet-enabled cognitive–behavioural therapy for depression and anxiety. BJPsych Open. 2018;4:411–418. doi: 10.1192/bjo.2018.57.
    1. Chand S.P., Grossberg C.T. How to adapt cognitive-behavioral therapy for older adults. Curr. Psychiatr. 2013;12:10–15.
    1. Clark D.M. Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Annu. Rev. Clin. Psychol. 2018;14:159–183. doi: 10.1146/annurev-clinpsy-050817-084833.
    1. Clark D.M., Canvin L., Green J., Layard R., Pilling S., Janecka M. Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet. 2018;391:679–686. doi: 10.1016/S0140-6736(17)32133-5.
    1. Community and Mental Health team, N.D. NHS Digital; Leeds: 2016. Psychological Therapies, Annual Report on the use of IAPT services: England 2015-16.
    1. Cosci F., Fava G.A., Sonino N. Mood and anxiety disorders as early manifestations of medical illness: a systematic review. Psychother. Psychosom. 2015;84:22–29. doi: 10.1159/000367913.
    1. Cuijpers P., Karyotaki E., Reijnders M., Huibers M.J.H. Who benefits from psychotherapies for adult depression? A meta-analytic update of the evidence. Cogn. Behav. Ther. 2018;47:91–106. doi: 10.1080/16506073.2017.1420098.
    1. Cuijpers P., Noma H., Karyotaki E., Vinkers C.H., Cipriani A., Furukawa T.A. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. 2020;19:92–107. doi: 10.1002/wps.20701.
    1. DeRubeis R.J., Cohen Z.D., Forand N.R., Fournier J.C., Gelfand L.A., Lorenzo-Luaces L. The personalized advantage index: translating research on prediction into individualized treatment recommendations. A demonstration. PLoS One. 2014;9:e83875. doi: 10.1371/journal.pone.0083875.
    1. Djernes J.K. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr. Scand. 2006;113:372–387. doi: 10.1111/j.1600-0447.2006.00770.x.
    1. Evans M., Mottram P. Diagnosis of depression in elderly patients. Adv. Psychiatr. Treat. 2000;6:49–56. doi: 10.1192/apt.6.1.49.
    1. Fava G.A. Well-being therapy: current indications and emerging perspectives. Psychother. Psychosom. 2016;85:136–145. doi: 10.1159/000444114.
    1. Fava G.A., Cosci F., Sonino N. Current psychosomatic practice. Psychother. Psychosom. 2016;86:13–30. doi: 10.1159/000448856.
    1. Fisher D.J., Carpenter J.R., Morris T.P., Freeman S.C., Tierney J.F. Meta-analytical methods to identify who benefits most from treatments : daft, deluded, or deft approach ? most from particular treatments or other broad approaches used for testing such. BMJ Br. Med. J. 2017;356:1–6. doi: 10.1136/bmj.j573.
    1. Gould R.L., Coulson M.C., Howard R.J. Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. J. Am. Geriatr. Soc. 2012;60:218–229.
    1. Gowling S., Persson J., Holt G., Ashbourne S., Bloomfield J., Shortland H., Bate C. Richmond wellbeing service access strategy for older adults. BMJ Qual. Improv. Reports. 2016;5 doi: 10.1136/bmjquality.u206099.w2510. u206099.w2510.
    1. Haigh E.A.P., Bogucki O.E., Sigmon S.T., Blazer D.G. Depression among older adults: a 20-year update on five common myths and misconceptions. Am. J. Geriatr. Psychiatry. 2018;26:107–122. doi: 10.1016/j.jagp.2017.06.011.
    1. He W., Goodkind D., Kowal P. U.S. Government Printing Office; Washington DC: 2016. An Aging World : 2015 International Population Reports. P95/09-1.
    1. Kazmi H., Walker Z., Booij J., Khan F., Shah S., Sudre C.H., Buckman J.E.J., Schrag A.-E. Late onset depression: dopaminergic deficit and clinical features of prodromal Parkinson's disease: a cross-sectional study. J. Neurol. Neurosurg. Psychiatry. 2021;92:158–164. doi: 10.1136/jnnp-2020-324266.
    1. Laidlaw K., Thompson L.W., Gallagher-Thompson D., Dick-Siskin L. John Wiley & Sons; Ltd, Chichester: 2003. Cognitive Behaviour Therapy with Older People.
    1. Maust D.T., Blow F.C., Wiechers I.R., Kales H.C., Marcus S.C. National trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care. J. Clin. Psychiatry. 2017;78:e363–e371. doi: 10.4088/JCP.16m10713.
    1. McHugh R.K., Whitton S.W., Peckham A.D., Welge J.A., Otto M.W. Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. J. Clin. Psychiatry. 2013;74:595–602. doi: 10.4088/JCP.12r07757.
    1. Mental Health Taskforce, 2016. The Five Year Forward View for Mental Health.
    1. NHS Digital, 2020. Psychological Therapies, Annual report on the use of IAPT services 2019-20.
    1. NHS Digital, 2019. Psychological Therapies, Annual report on the use of IAPT services 2018-19.
    1. NICE Common mental health problems: identification and pathways to care. Clin. Guidel. 2011:1–55. doi: 10.1021/cm0493546.
    1. Office for National Statistics, 2019. Overview of the UK Population, Overview of the UK population August 2019.
    1. Ogrodniczuk J.S., Piper W.E., Joyce A.S. Treatment compliance in different types of group psychotherapy: exploring the effect of age. J. Nerv. Ment. Dis. 2006;194:287–293. doi: 10.1097/01.nmd.0000207366.49820.85.
    1. Rothwell P.M. Subgroup analysis in randomised controlled trials : importance, indications, and interpretation. Lancet. 2005;365:176–186.
    1. Royston P., White I.R. Multiple Imputation by Chained Equations (MICE): Implementation in Stata. J. Stat. Softw. 2011;45:1–20. doi: 10.1002/mpr.329.Multiple.
    1. Sanglier T., Saragoussi D., Milea D., Auray J.P., Valuck R.J., Tournier M. Comparing antidepressant treatment patterns in older and younger adults: A claims database analysis. J. Am. Geriatr. Soc. 2011;59:1197–1205. doi: 10.1111/j.1532-5415.2011.03457.x.
    1. Saunders R., Buckman J.E.J., Cape J., Fearon P., Leibowitz J., Pilling S. Trajectories of depression and anxiety symptom change during psychological therapy. J. Affect. Disord. 2019;249:327–335. doi: 10.1016/j.jad.2019.02.043.
    1. Saunders R., Cape J., Leibowitz J., Aguirre E., Jena R., Cirkovic M., Wheatley J., Main N., Pilling S., Buckman J.E.J. Improvement in IAPT outcomes over time: are they driven by changes in clinical practice? Cogn. Behav. Ther. 2020;13:1–15. doi: 10.1017/s1754470x20000173.
    1. Saz P., Dewey M.E. Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int. J. Geriatr. Psychiatry. 2001;16:622–630. doi: 10.1002/gps.396.
    1. Stanley M.A., Wilson N.L., Novy D.M., Rhoades H.M., Wagener P.D., Greisinger A.J., Cully J.A., Kunik M.E. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care a randomized clinical trial. JAMA - J. Am. Med. Assoc. 2009;301:1460–1467. doi: 10.1001/jama.2009.458.
    1. StataCorp Stata Statistical Software: Release 16. Stata Stat. Softw. 2019 doi: 10.2307/2234838.
    1. Tamblyn R., Bates D.W., Buckeridge D.L., Dixon W., Forster A.J., Girard N., Haas J., Habib B., Kurteva S., Li J., Sheppard T. Multinational comparison of new antidepressant use in older adults: a cohort study. BMJ Open. 2019;9 doi: 10.1136/bmjopen-2018-027663.
    1. Unützer J., Patrick D.L., Diehr P., Simon G., Grembowski D., Katon W. Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. Int. Psychogeriatrics. 2000;12:15–33. doi: 10.1017/s1041610200006177.
    1. World Health Organization, 2016. Mental health and older adults [WWW Document]. Media Cent.
    1. Zimmerman M., Mattia J.I., Posternak M.A. Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice? Am. J. Psychiatry. 2002;159:469–473. doi: 10.1176/appi.ajp.159.3.469.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel