Cognitive-Behavioral therapies for major depression are as effective as pharmacotherapy. Among the elderly, minor depression is far more common than major depression in both the community and in primary care settings. If older persons are to receive any treatment for depression, it is most likely to be initiated in primary care. Nevertheless, there is a dearth of controlled studies of psychosocial interventions for minor depression in primary care. To address this problem a multi-site study was conducted that compared a brief form of cognitive-behavioral treatment (Problem-Solving Treatment for Primary Care or PST-PC), an antidepressant, and a placebo. This presentation will discuss the cognitive-behavioral treatment and predictors of its benefit.
This report is based on combined data from a study with two parallel multi-site randomized placebo controlled trials of two age groups. In the original study over 200 patients were randomized to PST-PC. In this analysis, patient, therapist, and process variables were evaluated for their ability to predict remission of minor depression or dysthymia in patients treated with PST-PC. In addition, post treatment follow-up was obtained. The most salient predictors of remission were the ability to understand the PST-PC rationale and to apply the PST-PC procedure in early treatment sessions, having a cognitive-behavioral therapist, and for dysthymia, having a lower depression severity level at baseline. The beneficial effect of perceived social support primarily in control groups suggests that those with greater perceived social support and minor depression may be more likely to have a positive response to non-specific clinical treatment components.
Nonspecific treatment factors common to both PST-PC and to active control conditions appear potent and may be of benefit for persons with minor depression. In addition, post-treatment follow-up suggests a need for some matching of continuation and maintenance treatment to patient characteristics. These results provide preliminary evidence of some factors associated with an optimal response to PST-PC and when to recommend PST-PC over nonspecific counseling.
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