Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials

Abstract

Objectives: To review the effectiveness of cognitive behavioral therapy (CBT) for depression in older people, together with factors associated with its efficacy.

Design: Online literature databases and registers were searched for randomized controlled trials (RCTs) of CBT for depression in older people. Random-effects meta-analysis and meta-regression were conducted.

Setting: Studies involving participants from the community and inpatient and outpatient clinical settings were included in the meta-analysis.

Participants: Older people with major or minor depression, dysthymia, or depressive symptoms.

Measurements: Evidence-based outcome measures of depression.

Results: Four hundred eighty-five studies were identified, of which 23 were included. At the end of the intervention, CBT was significantly more effective at reducing depressive symptoms (irrespective of whether rated by clinicians or participants) than treatment as usual (TAU) or being on a waiting list but not than active controls. The same pattern of results was found for 6-month follow-up. At all other time-points, pooled effect sizes in favor of CBT were nonsignificant. Clinician-rated outcome measures resulted in larger effect sizes in favor of CBT than self-rated measures. No significant differences in efficacy were found between CBT and other treatment (pharmacotherapy and other psychotherapies). Meta-regression analyses revealed four factors that predicted effect sizes for comparisons between CBT and control conditions, including whether concurrent pharmacotherapy was allowed.

Conclusion: CBT for depression in older people is more effective than waiting list or TAU, but greater efficacy than active controls or other treatment has not been demonstrated. More high-quality RCTs comparing CBT with active controls need to be conducted before firm conclusions can be drawn about the efficacy of CBT for depression in older people. Other treatment approaches that could be contrasted with or augment CBT (e.g., pharmacotherapy) also need to be explored further.