PSYC 636 Week 3 Treatment Paper: Annotated Bibliography Example

Treatment Paper Annotated Bibliography: Four Trials of Treatment for Depression in Later Life

Selected Condition and Sources

The treatment paper will address depression in later life, a common and undertreated condition among adults over 65. The four trials below were chosen to cover the settings a treatment plan must consider: the primary care office where most older adults are seen, the home and community, psychotherapy adapted to age-related cognitive change and treatment that draws on a client's faith.

Annotated Bibliography

Areán, P. A., Raue, P., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Alexopoulos, G. S. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. American Journal of Psychiatry, 167(11), 1391-1398. https://doi.org/10.1176/appi.ajp.2010.09091327

Areán et al. (2010) enrolled 221 depressed adults past 65 whose testing showed executive dysfunction, meaning trouble planning and shifting between tasks, and assigned them at random to twelve weeks of either problem-solving therapy or supportive therapy. Problem-solving therapy teaches clients to define problems, generate solutions and test them in a structured sequence. Both groups got better, yet by week 12 the problem-solving clients had lower symptom scores and were more often classed as responders or in remission. This group of older adults often responds poorly to antidepressants, which gives the finding clinical importance. Because problem-solving therapy breaks tasks into concrete steps, it seems to compensate for the very planning difficulties that make these clients hard to treat, and it can be delivered by trained counselors rather than only by psychologists. The trial is randomized and reasonably large, though it compared two psychotherapies and did not test either against medication. In the treatment paper, it will support recommending problem-solving therapy for an older client whose depression accompanies cognitive slowing.

Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P., Kulzer, J., Gray, S., Collier, C., & LoGerfo, J. (2004). Community-integrated home-based depression treatment in older adults: A randomized controlled trial. JAMA, 291(13), 1569-1577. https://doi.org/10.1001/jama.291.13.1569

This trial by Ciechanowski et al. (2004) tested PEARLS, a home-based program delivered through senior service agencies, with 138 older adults who had minor depression or dysthymia and received services such as meal delivery or case management. Counselors visited participants at home over 19 weeks and used problem-solving treatment, behavioral activation through pleasant events and support from a psychiatrist when needed. A year after enrollment, 43% of PEARLS clients, against 15% in usual care, had seen their symptom scores drop by at least half, and remission was also more frequent. The sample was small and limited to one city, but the effect was large, and the program was delivered by social service staff rather than clinic specialists. That detail matters, since many depressed older adults never reach a mental health office but do receive meals, transportation or case management. The paper will use it to show how treatment can reach homebound older adults.

Koenig, H. G., Pearce, M. J., Nelson, B., Shaw, S. F., Robins, C. J., Daher, N. S., Cohen, H. J., Berk, L. S., Bellinger, D. L., Pargament, K. I., Rosmarin, D. H., Vasegh, S., Kristeller, J., Juthani, N., Nies, D., & King, M. B. (2015). Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: A pilot randomized trial. Journal of Nervous and Mental Disease, 203(4), 243-251. https://doi.org/10.1097/NMD.0000000000000273

In this pilot, Koenig et al. (2015) randomized 132 adults aged 18 to 85 with major depression and a chronic medical illness to ten sessions of religiously integrated or conventional cognitive behavioral therapy, delivered largely by telephone. The religious version used the client's own faith tradition to challenge unhelpful thoughts, drawing on scriptures, prayer and religious beliefs. Both groups improved substantially and did not differ overall, but religious therapy appeared somewhat more effective among participants who were more religious. Its pilot status, broad age range and lack of a no-treatment group limit the conclusions. Still, the finding that a faith-based adaptation worked as well as standard therapy reassures clinicians who worry that bringing religion into treatment might dilute an evidence-based method, and it suggests the opposite may hold for devout clients. The final paper will cite it when discussing how faith can be incorporated into evidence-based treatment for religious older clients.

Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, E. H. B., Areán, P. A., Hegel, M. T., Tang, L., Belin, T. R., Oishi, S., & Langston, C. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288(22), 2836-2845. https://doi.org/10.1001/jama.288.22.2836

The IMPACT trial, reported by Unützer et al. (2002), took in 1,801 depressed patients past 60 from 18 primary care clinics in five states and assigned them by lottery to collaborative care or to the care their clinic usually gave. A depression care manager, supported by the patient's physician and a psychiatrist, offered education, antidepressant management or brief problem-solving therapy and adjusted treatment in steps. By the twelve-month mark, 45% of collaborative care patients had cut their symptom scores at least in half, against 19% of usual care patients, and they also functioned better and rated their quality of life higher. Its size and diverse sites, drawn from eight health care organizations, make it the strongest of the four sources, and later follow-up reports suggested that the benefits outlasted the year of active care. Because the model uses staff most clinics already have, it is also the most realistic to adopt. The paper will use it as the framework for organizing care across providers.