In the present study, we analyzed the effects of psychological treatments on depressed Chinese elderly inpatients with significant medical comorbidity. Psychological treatments showed large effects on their depressive symptoms, which is similar to the findings of psychological treatments for depression in older adults in the general population [20
]. Some studies found that older depressed adults with significant medical comorbidity may show lower response to psychological treatments for depression [22
], while other revealed that psychological treatments for late-life depression are effective among the terminally ill [41
]. The present result may be due to the following reasons. First, from the perspective of life-span development, older adults still have the ability to acquire new knowledge and skills and to use them in their daily life [42
]. Second, given that there were high levels of comorbidity in the samples, which increased the complexity of treatment, the integrative psychotherapy focusing on different types of behaviors, problems, or symptoms may be advantageous [43
]. All the psychological treatments in the present study comprise integrative psychotherapy, which may increase the treatment effects. Third, compared to outpatient samples who may have higher drop-out rates because of transportation and competing demands [21
], all of the samples in our study were inpatients who had adequate time and appropriate locations to receive psychological treatments, thus with a reduced risk for treatment drop-out. Recent studies emphasized the issues of compliance and dropout in treatment research on older people, and claimed that the drop-out rate served as an important indicator of therapeutic effectiveness [45
]. Therefore, the large treatment effect in the present study may be due to the absence of drop-out. Fourth, the psychological treatments were executed by doctors who are highly respected by patients in Chinese culture, which may have improved not only compliance but also motivation for receiving treatment in patients. In addition, it is very well possible that the inpatients were concerned that it would reduce the quality of care they receive from their doctors if they refused to participate in the interventions initiated by their doctors. This is also reflected by absence of drop-out in all of the studies. Fifth, having a care-as-usual control group rather than an active control group (such as other psychotherapy or pharmacotherapy) may have increased the effect sizes.
Since depression may influence treatment for significant medical comorbidity in patients, the psychological treatment of depression might improve the functional health of patients, contributing to an improvement in their significant medical comorbidity as well. This has been rarely examined in previous studies [7
]. Furthermore, there is no meta-analysis to test this issue yet. In our present study, we found that psychological treatments have moderate effects on medical comorbidity among Chinese elderly inpatients. For example, psychotherapies could improve somatic function, increase quality of life and hasten recovery.
The present study has several limitations. First, a relatively small number of studies were used in this meta-analysis, which means the results should be interpreted with caution. The low number of studies also limits the possibility of conducting subgroup analyses to identify some potential important moderators such as the categories of significant medical comorbidity, the treatment formats or treatment intensity that may also affect the effect sizes. Second, we found that the quality of the included studies in the present study was not optimal. For example, many studies did not report whether assignment to conditions was executed by an independent person, or whether blinding of assessors was conducted. Third, because follow-up results after post-test were not reported, we do not know whether there are long term effects. Fourth, the psychological treatments of all studies were integrative, so we could not compare the effects of different psychotherapies in this special population. Fifth, all studies were conducted in China, so whether the present results could be extended to Western populations needs a more comprehensive meta-analysis including studies conducted in Western countries.
Despite these limitations, we firmly conclude that psychological treatments are efficacious for Chinese elderly inpatients with significant medical comorbidity. Though the point was concluded based upon Chinese samples, it may still have important implications. First, there is a high comorbidity rate in older adults' depression and physical diseases. Second, a large number of inpatients with significant medical comorbidity who suffer depression go undetected and untreated [7
]. And third, older adults prefer receiving psychotherapy to taking antidepressant medication due to the adverse effects of antidepressants [47
]. Therefore, general practitioners should pay more attention to psychological treatments of the depressive symptoms in older inpatients with significant medical comorbidity in medical settings, as psychological treatments are not only effective for reducing depressive symptoms, but also efficacious for alleviating somatic symptoms. Another important and helpful advice from the present research is that the therapists should also pay more attention to improving the patients' motivation for psychological treatments in order to reduce the drop-out rate in this population. In addition, this study also suggested that the psychotherapies widely used in Western countries are also efficacious in Eastern culture context.