Serfaty Marc Antony, Haworth Deborah, Blanchard Martin, Buszewicz Marta, Murad Shahed, King Michael
Department of Mental Health Sciences, University College Medical School, Rowland Hill St, London NW3 2PF, England.
Arch Gen Psychiatry. 2009 Dec;66(12):1332-40. doi: 10.1001/archgenpsychiatry.2009.165.
In older people, depressive symptoms are common, psychological adjustment to aging is complex, and associated chronic physical illness limits the use of antidepressants. Despite this, older people are rarely offered psychological interventions, and only 3 randomized controlled trials of individual cognitive behavioral therapy (CBT) in a primary care setting have been published.
To determine the clinical effectiveness of CBT delivered in primary care for older people with depression.
A single-blind, randomized, controlled trial with 4- and 10-month follow-up visits.
A total of 204 people aged 65 years or older (mean [SD] age, 74.1 [7.0] years; 79.4% female; 20.6% male) with a Geriatric Mental State diagnosis of depression were recruited from primary care.
Treatment as usual (TAU), TAU plus a talking control (TC), or TAU plus CBT. The TC and CBT were offered over 4 months.
Beck Depression Inventory-II (BDI-II) scores collected at baseline, end of therapy (4 months), and 10 months after the baseline visit. Subsidiary measures were the Beck Anxiety Inventory, Social Functioning Questionnaire, and Euroqol. Intent to treat using Generalized Estimating Equation and Compliance Average Causal Effect analyses were used.
Eighty percent of participants were followed up. The mean number of sessions of TC or CBT was just greater than 7. Intent-to-treat analysis found improvements of -3.07 (95% confidence interval [CI], -5.73 to -0.42) and -3.65 (95% CI, -6.18 to -1.12) in BDI-II scores in favor of CBT vs TAU and TC, respectively. Compliance Average Causal Effect analysis compared CBT with TC. A significant benefit of CBT of 0.4 points (95% CI, 0.01 to 0.72) on the BDI-II per therapy session was observed. The cognitive therapy scale showed no difference for nonspecific, but significant differences for specific factors in therapy. Ratings for CBT were high (mean [SD], 54.2 [4.1]).
Cognitive behavioral therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects.
isrctn.org Identifier: ISRCTN18271323.
在老年人中，抑郁症状很常见，对衰老的心理调适很复杂，且相关的慢性躯体疾病限制了抗抑郁药的使用。尽管如此，老年人很少接受心理干预，在初级保健环境中仅发表了3项关于个体认知行为疗法（CBT）的随机对照试验。
确定在初级保健中为老年抑郁症患者提供CBT的临床疗效。
一项单盲、随机、对照试验，随访4个月和10个月。
从初级保健机构招募了总共204名65岁及以上的老年人（平均[标准差]年龄，74.1[7.0]岁；79.4%为女性；20.6%为男性），根据老年精神状态诊断为抑郁症。
常规治疗（TAU）、TAU加谈话对照（TC）或TAU加CBT。TC和CBT为期4个月。
在基线、治疗结束时（4个月）和基线访视后10个月收集贝克抑郁量表-II（BDI-II）评分。辅助指标为贝克焦虑量表、社会功能问卷和欧洲五维健康量表。采用广义估计方程进行意向性分析和依从性平均因果效应分析。
80%的参与者接受了随访。TC或CBT的平均疗程数略多于7次。意向性分析发现，与TAU和TC相比，BDI-II评分分别改善了-3.07（95%置信区间[CI]，-5.73至-0.42）和-3.65（95%CI，-6.18至-1.12），有利于CBT。依从性平均因果效应分析将CBT与TC进行比较。观察到每次治疗疗程CBT在BDI-II上有0.4分（95%CI，0.01至0.72）的显著益处。认知治疗量表在非特异性方面无差异，但在治疗的特异性因素方面有显著差异。对CBT的评分较高（平均[标准差]，54.2[4.1]）。
认知行为疗法是治疗老年抑郁症患者的有效方法，似乎与其特定效果相关。
isrctn.org标识符：ISRCTN18271323。
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