An innovative psychological treatment can help older people who experience lower-severity depression, say UK researchers, adding that it can also prevent more severe depression developing.
The study authors, led by York University researchers, noted that one in seven older people met criteria for full-blown depression and those at greatest risk were lonely or had long-term conditions.
“Older people were encouraged to re-engage with social activity”
The CASPER trial, the largest-ever study of its kind, focussed on older people with lower-severity symptoms who are at the highest risk of becoming clinically depressed but are under the guideline threshold to be treated with drugs.
The results of the trial, funded by the National Institute for Health Research, suggested promise for a simple and low-cost intervention to reduce depression symptoms in patients aged 65 and over.
Those who received the intervention were also less likely to be more severely depressed after a year, were less anxious and had improved quality of life compared to patients receiving usual care.
The trial, published in the Journal of the American Medical Association, was conducted in 32 primary care centres, involving 705 participants aged 65 years or older who were followed up for 12 months.
Around half the participants were offered “collaborative care”, based on behavioral activation, and completed an average of six weekly sessions, while a control group received usual primary care.
“We hope that our research will improve the lives of older people throughout the UK”
The intervention consisted of a structured programme of reducing the frequency of negatively reinforced avoidant behaviours in parallel with increasing the frequency of positively reinforcing behaviours to improve functioning and raise mood.
Kate Bosanquet, from the University of York, said: “We developed our ‘collaborative care’ intervention after consulting with older people and considering evidence about effective treatments for depression.
“We used a simple psychological approach known as behavioural activation. Older people were encouraged to re-engage with social activity and to find alternative ways of being mentally or physically active,” she said.
“This is important since people with depression commonly withdraw from these types of activities and this makes things worse,” she noted.
The primary outcome of the trial was self-reported depression severity at four-month follow-up on the nine-item Patient Health Questionnaire.
Collaborative care resulted in lower PHQ-9 scores versus usual care at four months – mean score with collaborative care was 5.36 versus 6.67 for usual care. Treatment differences remained at 12 months with scores of 5.93 and 7.25, respectively.
The study team, which included researchers from Leeds Community Healthcare NHS Trust, Northumberland Tyne and Wear NHS Foundation Trust and Tees Esk and Wear Valleys NHS Foundation Trust, said they were planning to strain health service staff to deliver the intervention.
Lead author Professor Simon Gilbody added: “There is currently very little in the way of psychological treatment offered for older people. We hope that our research will improve the lives of older people throughout the UK.”