Depression Treatment: What Predicts Persistent Depression in Older Adults Across Europe? Utility of Clinical and Neuropsychological Predictors From the SHARE Study.

What predicts persistent depression in older adults across Europe? Utility of clinical and neuropsychological predictors from the SHARE study.

Filed under: Depression Treatment

J Affect Disord. 2012 Nov 19;
Gallagher D, Savva GM, Kenny R, Lawlor BA

BACKGROUND: Depression in later life frequently persists and perpetuating factors are of immediate therapeutic relevance to clinicians. No studies of this scale have examined both clinical and neuropsychological predictors of persistent depression in a cross-national European context. METHODS: 4095 community dwelling older adults (?50yr) with clinically signficant depression (EURO-D?4) from eleven European countries in the Survey of Heath, Ageing, and Retirement in Europe (SHARE) were followed for a median of 28 months. Logistic regression analyses were conducted to determine predictors of persistent depression. RESULTS: 2187 (53.4%) remained depressed at follow up. Independent predictors included: female gender, baseline functional impairment, functional decline, physical symptoms, past history of depression, increased severity of depression, early age of onset (<50yr), life events, financial distress and country of residence. Neuropsychological variables were associated with persistent depression but not independently of other variables. LIMITATIONS: The assessment of depression was by self-report and the data source did not contain a number of potentially relevant predictors. CONCLUSION: Individuals at risk of persistent depression may be identified and targeted for intervention. Therapeutic interventions should adopt a multimodal approach to optimise current function, prevent further functional decline and treat symptoms of depression. Country of residence may be associated with further modifiable variables. HubMed – depression

 

Brief dynamic therapy and depression severity: A single-blind, randomized study.

Filed under: Depression Treatment

J Affect Disord. 2012 Nov 19;
Rosso G, Martini B, Maina G

BACKGROUND: Brief dynamic therapy (BDT) has been shown to be effective in treating depressive disorders. Nevertheless, whether its effect is related to the severity of depression is still unknown. The aim of this study was to analyze whether the efficacy of BDT is related to severity of depressive symptoms in patients with mild to moderate unipolar depressive disorders. METHODS: A randomized clinical trial compared BDT with brief supportive psychotherapy (BSP) in 88 outpatients with depressive disorders. Two subgroups of patients were considered for statistical analysis: with mild depressive disorders (HAM-D(17) baseline score: 8-13) and with moderate depressive disorders (HAM-D(17) baseline score: 14-18). Patients were assessed at start of treatment (baseline-T0), at the end of treatment (T1) and at 6-month follow-up (T2). RESULTS: In the subgroup of patients with mild depressive disorders, no statistically significant differences emerged between the two treatments on all efficacy measures. In the subgroup of patients with moderate depressive disorders, the remission rates of patients treated with BDT were higher than those of patients treated with BSP at 6 month of follow-up (90.5% vs. 34.8%: p<.005). LIMITATIONS: The sample size was relatively small; a longer follow-up period should be considered to assess the efficacy of BDT in terms of prevention of recurrences. CONCLUSIONS: The efficacy of BDT in treating depressive disorders is higher in moderate than in mild depression. HubMed – depression

 

Moderators of treatment effectiveness for war-affected youth with depression in northern Uganda.

Filed under: Depression Treatment

J Adolesc Health. 2012 Dec; 51(6): 544-50
Betancourt TS, Newnham EA, Brennan RT, Verdeli H, Borisova I, Neugebauer R, Bass J, Bolton P

As we build the evidence base of interventions for depression among war-affected youth, it is critical to understand factors moderating treatment outcomes. The current study investigated how gender and history of abduction by Lord’s Resistance Army rebels moderated treatment outcomes for war-affected youth.The study-a three-armed, randomized, controlled trial-was conducted with internally displaced war-affected adolescents in northern Uganda. Participants with significant depression symptoms (N = 304; 57% female; 14-17 years of age) were randomly assigned to an interpersonal psychotherapy group (IPT-G), a creative play/recreation group, or a wait-list control condition. Secondary analyses were conducted on data from this randomized controlled trial.A history of abduction by Lord’s Resistance Army rebels was reported by 42% of the sample. Gender and abduction history interacted to moderate the effectiveness of IPT-G for the treatment of depression. In the IPT-G intervention arm, treatment effectiveness was greatest among female subjects without an abduction history, with effect size = 1.06. IPT-G was effective for the treatment of depression for both male and female subjects with a history of abduction (effect size = .92 and .50, respectively). Male subjects with no abduction history in IPT-G showed no significant improvement compared with those in the control conditions.Abduction history and gender are potentially important moderators of treatment effects, suggesting that these factors need to be considered when providing interventions for war-affected youth. IPT-G may be an effective intervention for female subjects without an abduction history, as well as for both male and female former child soldiers, but less so for male subjects without an abduction history.
HubMed – depression

 

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