Older patients with depression and executive dysfunction represent a population with significant disability and high likelihood of failing pharmacotherapy.
To examine whether Problem Solving Therapy (PST) reduces disability more than Supportive Therapy (ST) in older patients with depression and executive dysfunction, and whether this effect is mediated by improvement in depressive symptoms.
Randomized controlled trail, with participant recruitment from 12/02-11/07 and follow-up for 36 weeks.
Weill Cornell and University of California, San Francisco.
Adults (>59 years) with major depression and executive dysfunction.
12 sessions of either PST modified for older depressed adults with executive impairment, or ST.
Main Outcome Measure
Disability as quantified by the World Health Organization Assessment Schedule II (WHODAS II)-12 item form.
653 individuals were referred to this study, 221 of whom met criteria and were randomized to PST or ST. PST and ST led to comparable improvement of disability in the first 6 weeks of treatment, but a more prominent reduction in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and higher number of previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was in part due to greater reduction of disability by PST. While disability increased during the 24 weeks following the end of treatment, the advantage of PST over ST-treated patients was retained.
This study suggests that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.