Table 2.
Summary of dyadic and family-oriented RCTs to treat depression in older adults
| First author (year) country | Sample | Source(s) of recruitment | Mean age, in years | Intervention groups | Intervention duration | Main outcome | Between-group findings for patients | Between-group findings for support persons | Effect size (r)^ |
|---|---|---|---|---|---|---|---|---|---|
| Alexopoulos et al. (2012)a USA | 24 post-stroke depression patients and a close family member | rehabilitation hospital | patients: 70.8 ± 8.5 support persons: NR |
1) ecosystem focused therapy (EFT) 2) education on stroke and depression (ESD) |
3 months | remission of depression (Hamilton Depression Rating Scale <10) | EFT was more efficacious than ESD in reducing patients depressive symptoms, disability, and improving remission rates. EFT: pre HRSD = 20.4 (9.19); post HRSD = 8.2 (6.63) | No outcomes were reported. | 0.39 |
| Eisdorfer et al. (2003) USA | 225 patients and their spouses/family members | memory disorder clinics, primary care clinics, social service agencies, and physician offices. | patients: 68.5 ± 11.3 support persons: NR |
1) structural (family) ecosystems therapy (SET) 2) SET + Computer-telephone integrated system (CTIS) 3) minimal support control (MSC) |
12 months | depressive symptoms (Center for Epidemiological Studies Depression Scale) | Patients in the SET + CTIS experienced a decrease in depression relative to SET and MSC. | No outcomes were reported. | - |
| Gaugler et al. (2008) USA | 406 patients and an additional family member | NYU Aging and Dementia Research Center, local Alzheimer’s chapters | patients: 71.3 ± 9.1 support persons: NR |
1) individual and family counseling 2) usual care |
4 months | depressive symptoms (Geriatric Depression Scale) | Patients in the intervention group experienced significantly lower depression than those in usual care. | No outcomes were reported. | 0.06 |
| Joling et al. (2008, 2012) Netherlands | 192 depressed patients and an additional family member or friend | memory clinics, specialized mental health care clinics | patients: 69.5 ± 10.3 support persons: NR |
1) family meetings intervention 2) treatment as usual (TAU) |
12 months | 12-month incident depressive disorder (Mini International Neuropsychiatric Interview) | Compared with TAU, the family meetings intervention did not significantly reduce patients risk of developing a depressive disorder and did not reduce symptom burden (CESD change = 1.51). | No outcomes were reported. | 0.02 |
| Mittelman (1995, 2000) USA | 206 patients and an additional family member | ADRC, Alzheimer’s Association of NY, elderly day care centers | patients: 86% ≥60 support persons: NR |
1) individual and family counseling 2) treatment as usual (TAU) |
4 months | depressive symptoms (Geriatric Depression Scale) | Individual and family counseling significantly decreased patients depression, but not until 8 months post-treatment (GDS change = 0.03, SD = 4.56) | No outcomes were reported. | 0.19 |
| Mittelman et al. (2004) USA | 406 patients and an additional family member | ADRC, Alzheimer’s Association of NY, media announcements, referrals from physicians and social workers | patients: 71.3 ± 9.0 support persons: NR |
1) enhanced counseling and family support 2) usual care |
4 months | depressive symptoms (Geriatric Depression Scale) | Patients in the treatment group had fewer depressive symptoms (GDS change = −1.1, SD + 5.0) than control persons. These effects sustained for 3.1 years post-baseline. | No mental health outcomes were reported. | 0.15, 0.05 |
| Mittelman et al. (2008) USA, UK, and Australia | 158 patients and an additional family member | outpatient research clinics | patients: NR support persons: NR |
1) individual and family counseling + patient pharmacotherapy 2) patient pharmacotherapy |
4 months | depressive symptoms (Beck Depression Inventory) | Compared with the control group, individual and family counseling significantly decreased patients depression across 2 years. | No outcomes were reported. | 0.11 |
| Shimodera et al. (2012); Shimazu et al. (2011) | 57 depressed patients and their primary family member | Department of Psychiatry, affiliated hospital in Japan | patients: 60 ± 13.8 support persons: 60.4 ± 11.1 |
1) family psychoeducation (FS) 2) treatment as usual (TAU) |
2 months | time to relapse (in days) | The FS group experienced more relapse free days (272; SD = 7.1) compared with the TAU group (214; SD = 90.8). | No mental health outcomes were reported. | 0.41 |
| Teri (1997) USA | 72 depressed patients and their spouses | geriatric & family services clinic, the ADRC | patients: 76.4 ± 8.2 support persons: NR |
1) behavior therapy-pleasant events (BT-PE) 2) behavior therapy-problem solving (BT-PT) 3) typical care control (TCC) 4) waitlist control (WLC) |
9 weeks | depressive symptoms (Hamilton Depression Rating Scale; Cornell Scale for Depression in Dementia) | Patients in both BT-PE and BT-PT showed significant improvements in depressive symptoms compared with a control condition. BT-PE: HDRS change = −5.3 (4.0); BT-PT: HDRS change = 3.8 (2.3) | Support persons in both behavioral treatments showed significant improvements in depressive symptoms compared with those in a control condition. | 0.41 |
| Wilz and Barskova (2007) Germany | 124 patients and their spouses | rehabilitation centers | patients: 64.7 ± 9.6 support persons: 62.7 ± 10.0 |
1) cognitive behavioral group intervention 2) informational control 3) standard care control |
8 months | depressive symptoms (Beck Depression Inventory) | Patients in the intervention groups showed significant declines in depression (BDI compared to controls, but not until 6 months post-intervention. | No mental health outcomes were reported. | 0.33 |
MDD, major depressive disorder; ADRC, Alzheimer’s Disease Research Center; NR, not reported.
a
Pilot study and/or preliminary feasibility study.