Quality of Research
Review Date: December 2006
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Gallagher, D. E., & Thompson, L. W. (1982). Treatment of major depressive disorder in older adult outpatients with brief psychotherapies. Psychotherapy: Theory, Research and Practice, 19(4), 482-490.
Gallagher, D. E., & Thompson, L. W. (1983). Effectiveness of psychotherapy for both endogenous and nonendogenous depression in older adult outpatients. Journal of Gerontology, 38(6), 707-712.  Study 2Gallagher-Thompson, D., Hanley-Peterson, P., & Thompson, L. (1990). Maintenance of gains versus relapse following brief psychotherapy for depression. Journal of Consulting and Clinical Psychology, 58(3), 371-374.
Thompson, L. W., Gallagher, D., & Breckenridge, J. S. (1987). Comparative effectiveness of psychotherapies for depressed elders. Journal of Consulting and Clinical Psychology, 55(3), 385-390.
Thompson, L. W., Gallagher, D., & Czirr, R. (1988). Personality disorder and outcome in the treatment of late-life depression. Journal of Geriatric Psychiatry, 21(2), 133-146. Study 3Thompson, L. W., Coon, D. W., Gallagher-Thompson, D., Sommer, B. R., & Koin, D. (2001). Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. American Journal of Geriatric Psychiatry, 9(3), 225-240. Study 4Laidlaw, K., Davidson, K., Toner, H., Jackson, G., Clark, S., Cross, S., et al. (2006). A randomized controlled trial of cognitive behavior therapy versus treatment as usual in the treatment of mild to moderate late life depression. Manuscript submitted for publication.
Supplementary Materials Crits-Christoph, P., Baronackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., et al. (1991). Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1(2), 81-91.
Laidlaw, K., Thompson, L. W., & Gallagher-Thompson, D. (2004). Comprehensive conceptualization of cognitive behaviour therapy for late-life depression. Behavioural and Cognitive Psychotherapy, 32, 389-399.
Letter of support for intervention from Dr. Forrest Scogin, Professor, University of Alabama. Dated September 25, 2006.
Report on reliability and validity of measures used. (n.d.). Unpublished report.
Outcomes
| Outcome 1: Symptoms of depression |
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Description of Measures
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Symptoms of depression were assessed using (1) the Hamilton Rating Scale, which is used to rate the level of depression and improvement of depressive symptoms over time; (2) the Beck Depression Inventory, a 21-item self-report scale assessing the intensity of depressive symptoms; (3) the Zung Self-Rating Depression Scale, a self-report scale indicating frequency of depressive symptoms; (4) the Geriatric Depression Scale, used to assess presence or absence of depressive symptoms for geriatric patients; and (5) the Depression Scale of the Brief Symptom Inventory, a self-report depression scale that assesses several categories of depression.
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Key Findings
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Patients reduced their depression symptoms after receiving any of the following: behavioral therapy, cognitive therapy, brief relational/insight psychotherapy, brief psychodynamic psychotherapy, desipramine therapy, CBT, CBT plus desipramine, and generic treatment as usual. However, improvement at 1-year follow-up was maintained more effectively by behavioral or cognitive therapy than by relational/insight therapy. Desipramine plus CBT therapy was more effective than CBT alone or desipramine alone in patients who were more severely depressed. In addition, larger treatment effect sizes were found with CBT compared with treatment as usual.
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Studies Measuring Outcome
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Study 1, Study 2, Study 3, Study 4
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Study Designs
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Experimental
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Quality of Research Rating
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3.1
(0.0-4.0 scale)
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| Outcome 2: Diagnosis of depression |
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Description of Measures
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This outcome was measured using structured clinical interviews that applied Research Diagnostic Criteria (RDC) to the Schedule for Affective Disorders and Schizophrenia--Lifetime version (SADS-L). The SADS-L was also used to establish RDC diagnostic criteria at the pretreatment, posttreatment, and follow-up stages. The Longitudinal Interval Follow-up Evaluation was used to ascertain retrospectively whether depressive episodes had occurred in the interval between follow-up evaluations.
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Key Findings
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Among 91 older adults initially diagnosed with an episode of major depressive disorder, between 52% and 70% did not meet criteria for RDC depressive disorder after treatment with cognitive therapy, behavioral therapy, or brief psychodynamic psychotherapy. Over time, patients not depressed at posttreatment remained depression-free longer than patients who had minor or major depressive disorders. At 6-month follow-up, clients who completed CBT were less likely to meet criteria for diagnoses of depression than clients who completed treatment as usual.
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Studies Measuring Outcome
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Study 2, Study 4
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Study Designs
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Experimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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| Outcome 3: Life satisfaction |
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Description of Measures
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Life satisfaction was assessed using (1) the Hopelessness Scale, a 20-item self-report measure of the extent of negative attitudes towards the future that is linked to risk of suicide in depression; (2) the Automatic Thoughts Questionnaire, a self-report measure that indicates the level of negative dysfunctional thoughts; (3) the Young Loneliness Inventory, a self-report measure that assesses extent of loneliness; (4) the Beck Hopelessness Scale, a 20-item self-report measure of the extent of negative attitudes towards the future (linked to risk of suicide in depression); and (5) the Penn State Worry Questionnaire, a 16-item self-report measure of an individual's tendency to worry.
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Key Findings
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Among older adults, measures of life satisfaction improved following treatment with cognitive therapy, behavioral therapy, or brief psychodynamic psychotherapy. At 6-month follow-up, CBT resulted in larger effect sizes for life satisfaction compared with treatment as usual.
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Studies Measuring Outcome
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Study 2, Study 4
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Study Designs
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Experimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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| Outcome 4: Coping strategies and involvement in pleasurable activities |
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Description of Measures
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Coping strategies and involvement in pleasurable activities were measured by (1) the World Health Organization Quality of Life Scale, a 20-item scale assessing satisfaction with various quality of life domains; (2) the Social Adjustment Scale, an interview and self-report scale used to assess level of social functioning; (3) the Behavioral Cognitive and Avoidance Coping Scales in the Health and Daily Living Questionnaire, a self-report scale where subjects indicate how they would deal with specific stressful situations; and (4) the Older Persons Pleasant Events Schedule, with which subjects review a list of pleasant activities and indicate how often they are doing them and whether or not they are pleasurable.
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Key Findings
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Patients improved in overall adjustment and coping after treatment with cognitive therapy, behavioral therapy, or brief psychodynamic psychotherapy. CBT produced improved environmental quality of life when applied to older adults with moderate depression (p < .03).
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Studies Measuring Outcome
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Study 2, Study 4
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Study Designs
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Experimental
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Quality of Research Rating
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2.3
(0.0-4.0 scale)
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| Outcome 5: Severity of other psychiatric symptoms |
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Description of Measures
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Severity of other psychiatric symptoms was measured using (1) the Global Severity and Anxiety subscales of the Brief Symptom Inventory, which assesses the client's level of anxiety; (2) the Brief Psychiatric Rating Scale, an interviewer measure that rates presence of severe psychiatric symptoms; and (3) the Schedule for Affective Disorder and Schizophrenia, a semistructured interview used to assess mental disorders as defined by the Research Diagnostic Criteria.
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Key Findings
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Patients reduced their psychiatric symptoms other than depression after treatment with cognitive therapy, behavioral therapy, or brief psychodynamic psychotherapy.
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Studies Measuring Outcome
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Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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2.6
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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55+ (Older adult)
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76.7% Female
23.3% Male
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93.3% White
3.3% Black or African American
3.3% Hispanic or Latino
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Study 2
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55+ (Older adult)
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67.4% Female
32.6% Male
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Data not reported/available
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Study 3
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55+ (Older adult)
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67% Female
33% Male
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Data not reported/available
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Study 4
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55+ (Older adult)
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72.5% Female
27.5% Male
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Data not reported/available
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Symptoms of depression
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4.0
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4.0
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3.3
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2.3
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2.1
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2.8
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3.1
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2: Diagnosis of depression
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3.5
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3.5
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3.0
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2.5
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2.0
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2.5
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2.8
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3: Life satisfaction
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3.7
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3.7
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3.0
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2.0
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2.0
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2.3
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2.8
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4: Coping strategies and involvement in pleasurable activities
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2.3
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2.3
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2.5
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2.3
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2.3
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2.5
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2.3
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5: Severity of other psychiatric symptoms
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3.0
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3.0
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3.0
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2.5
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2.0
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2.0
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2.6
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Study Strengths The studies made good use of reliable and valid measures. Given the nature of the target population, the developers did a good job of looking at attrition and missing data. Data evaluation was good. CBT clearly is effective with older adults, despite the treatment challenges that can be inherent with this population. The use of standardized manuals and appropriate training supports efficacy.
Study Weaknesses Concerns with severity, age, socioeconomic status, high function levels, and high exclusions all limit generalizability. Testing fatigue was a possibility for the elderly participants, who were tested very frequently in some studies. The use of interns as opposed to experienced therapists adds variables as well. One study lacked a tested fidelity instrument. The use of a wait-list control group in one study could be problematic as this could have led to other help-seeking behavior.
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Readiness for Dissemination
Review Date: December 2006
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Cognitive Behavioral Therapy for Late-Life Depression [PowerPoint presentation]
Dick, L., Gallagher-Thompson, D., Coon, D., Powers, D., & Thompson, L. (2005). Cognitive-behavioral therapy for late life depression: A client manual. Palo Alto, CA: Older Adult and Family Center, VA Palo Alto Health Care System.
Laidlaw, K., Thompson, L., Dick-Siskin, L., & Gallagher-Thompson, D. (2003). Cognitive behaviour therapy with older people. United Kingdom: John Wiley & Sons Ltd.
Thompson, L., Gallagher-Thompson, D., & Dick, L. (2005). Cognitive-behavioral therapy for late life depression: A therapist manual. Palo Alto, CA: Older Adult and Family Center, VA Palo Alto Health Care System.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.5
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1.5
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0.5
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1.8
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Dissemination Strengths The implementation materials include clearly explicated and detailed adaptations of cognitive behavioral therapy for older adults. Materials include a section for working with special issues, such as physical disabilities and comorbid anxiety, and provide "what if" scenarios with suggestions for handling challenging questions from clients. The manual provides sequencing for continual client feedback, which can be used to monitor the intervention's effectiveness. Training is available in the form of the traditional clinical model through postdoctorate or practicum training.
Dissemination Weaknesses Detailed information for administrators on the organizational requisites for effective implementation is not provided. No materials, resources, or technical assistance are available to support training or coaching in a more portable manner. No information is provided on developing a therapeutic relationship. Programmatic quality assurance measures to support intervention fidelity are not addressed.
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