Research projects

A randomised, controlled trial of two psychological interventions for patients with late-life depression who have co-morbid physical problems

Principal researcher

Professor Louise Sharpe1
Associate Professor Michael Nicholas1
Professor Patricia Arean2
Dr Tanya Covic3

Institution

1 The University of Sydney
2 University of California, San Francisco
3 University of Western Sydney

Funding

$399,875

Award type

National Priority Driven Research Program

Project completion year

2015

Project brief

Although there have been numerous trials of psychological interventions for patients with late-life depression, there continue to be major gaps in the literature. Few studies aim to treat depression in the context of ill health, despite the fact that many older adults have both depression and a chronic physical illness. There are also few studies that compare psychotherapies for late-life depression. This project aims to bridge these gaps, aiming specifically to evaluate two psychological therapies (i.e. problem solving therapy [PST] and cognitive-behavioural therapy [CBT]), both of which are definitely efficacious for the treatment of late-life depression in healthy older people, for patients with co-morbid physical illness(es). Further, the project aims to identify characteristics of older people that might differentially predict outcome following PST or CBT. Hence, the project aims to determine which of two interventions is most efficacious and whether different patient groups benefit from different approaches.

This project allows an opportunity to explore relationships between clinical characteristics and treatment response. Understanding differential treatment responses may lead to the ability to personalise treatment. The clinical characteristics found to be related to poor treatment response in late-life depression are executive dysfunction, rumination and affect deregulation. The hypothesis is that patients with deficits in these areas will respond best to treatments that specifically target the processes associated with poor response.

Anticipated practical outcomes, community benefits

One of the strengths of the project is that the outcomes will be very practical. Professor Arean has been involved in considerable efforts to translate knowledge about the treatment of late-life depression into practice in the USA. She will be able to share her experiences in the successful translation of knowledge to services. Her particular focus has been on increasing the access of underprivileged older people to psychosocial interventions that are evidence-based. This trial is another potential application of the development of an evidence base for a group of patients who are highly vulnerable, have complex needs and who have to date been largely neglected by the international literature. The results will lead to the development of evidence-based treatment for this group of patients.

The fact that the programs are relatively brief (12 sessions) means that, following the project, it is feasible for them to be rolled out into practice by psychologists working under the Medicare system. The timely nature of this research, as the new Medicare locals system is implemented, will also allow the team to maximise the integration of community-based health services such as links between GPs, psychologists and other health practitioners in the over-lapping priority areas of chronic disease, mental health, and aging, which are the focus of this project. Further, the fact that two of the investigators hold academic positions at institutions who are involved in the training of clinical psychologists (Sharpe, University of Sydney and Covic, University of Western Sydney) means that the further expertise developed through the successful completion of this project will be included in the teaching programs for the next generation of clinical psychologists.

Publications

Sharpe et al. Problem-solving versus cognitive restructuring of medically ill seniors with depression (PROMISE-D trial): study protocol and design. BMC Psychiatry 2012, 12:207