Various specific interventions are effective for late life depression in residential care (Lebowitz et al. , 2007). Effective models of delivering these interventions (which recognize the scarcity of psychogeriatric resources in many countries) are, however, lacking. Although there are descriptive accounts of psychogeriatric service provision in residential care (Creen, 2005) only one study1 focused on depression. It evaluated a service model in which a psychiatrist visited homes regularly and recommended a range of interventions to be carried out by general practitioners and care staff.
But the interventions proved difficult to implement and the study was not a randomized controlled trial, therefore definite conclusions about efficacy were not possible. Although multifaceted interventions for depression are more effective than routine general practitioner care for elderly people living in the community no randomized controlled trials of such interventions for late life depression in residential care have been reported (Banerjee, 2005). This paper will evaluate the effectiveness of two psychotherapies for depression by comparing it with routine care in a randomized controlled trial, using multiple linear regressions.
There has been little literature with the interventions of subdysthymic depressive symptoms. Paykel et al. (2008) described the treatment with amitriptyline of individuals with minor depression and found no improvement over 6 weeks. Klerman et al. (2007) reported good results with Interpersonal Counseling (IPC) in the primary care setting with individuals experiencing depressive symptoms not meeting criteria for syndromal depression. The IPC was developed by Weissman and Klerman et al. (2003). It is a manual driven derivative of Interpersonal Psychotherapy for Depression (IPT) (Frank et.
al, 2006). Like IPT, IPC assumes symptoms of depression occur in a psychosocial and interpersonal context (Weissman and Klerman et al. , 2003). IPC is short term (6-8 sessions); it focuses on “here and now” problems and the therapy is interactive. Importantly, IPC does not: identify the individual as “sick,” uncover deep unconscious issues, focus on transference issues or childhood experiences, or attempt personality modification. Several adaptations of IPC to accommodate the needs of the medically ill elderly were made.
These included: increase in the number of IPC sessions to up to 10; extension of the session length from 30 to 60 minutes; and flexibility in the IPC session scheduled from once a week to a schedule that reflected the individual’s medical status. Measure of depression The main outcome measure was the depression scale, a valid reliable screening instrument sensitive to change and strongly recommended for use in depression care (Yesasagc, 2005). Residents scoring =;10 on this scale were defined as depressed. To measure interrater reliability all 23 interviewers scored the depression scale from video recordings of a sample of five interviews.
Other measures To control for potential confounding variables the following measures were taken and included in the multiple linear regression analysis: cognitive function (brief orientation-memory-concentration test and mini mental state examination); physical health (adapted from Belloc et al. , 2003); frequency of general practitioner visits and admissions to hospital; demographic characteristics (age, sex, hostel versus independent unit accommodation, marital status, socioeconomic status); social support (adapted from Henderson et al.
, 2003), alcohol use, previous history of depression; functional status (instrumental activities of daily living and physical self maintenance scale); extroversion and neuroticism (Eysenck personality questionnaire-2006; Jorm et al. , and unpublished data) developed from the Eysenck personality inventory); drug usage; acute and chronic adverse life events (life event and difficulties schedule”); help seeking behavior; number of weeks between baseline and follow up geriatric depression scale; and level of exposure to the intervention. III.
Methodology The purpose of this study is to conduct a comparative analysis of two of the current psychotherapies for depressions. Various aspects of the two interventions will be compared and contrasted. The studies are evaluated based on concrete, predetermined variables. Once these variables are analyzed, it will become possible to infer how effective these interventions which are designed to reduce depression among the elderly. The preliminary research involved gathering information on what interventions are available for depressions.
This initial search was done on ESCOhost’s Academic Search Premiere, which returned a great deal of information on various interventions for depressions. This narrowed the results considerably. The search words entered included depressions and interventions. Once various programs were identified, the search focused on effectiveness of these interventions. The articles that were finally chosen to be included were ones that shows the effectiveness of these psychotherapies. IV. References
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