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Cited by 199Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major Depression

Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction: Effect on Disability

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Alexopoulos, George S., Raue, Patrick J., Kiosses, Dimitris N., Mackin, R. Scott, Kanellopoulos, Dora, McCulloch, Charles, Areán, Patricia A.·2011·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2010.177PMC PMC3018861
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Abstract

CONTEXT: Older patients with depression and executive dysfunction represent a population with significant disability and a high likelihood of failing pharmacotherapy. OBJECTIVES: To examine whether problem-solving therapy (PST) reduces disability more than does supportive therapy (ST) in older patients with depression and executive dysfunction and whether this effect is mediated by improvement in depressive symptoms. DESIGN: Randomized controlled trial. SETTING: Weill Cornell Medical College and University of California at San Francisco. PARTICIPANTS: Adults (aged >59 years) with major depression and executive dysfunction recruited between December 2002 and November 2007 and followed up for 36 weeks. Intervention Twelve sessions of PST modified for older depressed adults with executive impairment or ST. Main Outcome Measure Disability as quantified using the 12-item World Health Organization Disability Assessment Schedule II. RESULTS: Of 653 individuals referred to this study, 221 met the inclusion criteria and were randomized to receive PST or ST. Both PST and ST led to comparable improvement in disability in the first 6 weeks of treatment, but a more prominent reduction was noted in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and more previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was, in part, due to greater reduction in disability by PST. Although disability increased during the 24 weeks after the end of treatment, the advantage of PST over ST was retained. CONCLUSIONS: These results suggest that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00052091.

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  • Problem solving therapy was more effective than supportive therapy in reducing depression and disability in older adults with DED.

    “Problem solving therapy was more effective that supportive therapy in reducing depression and disability in older adults with DED162,163, a syndrome with poor response to antidepressants32–38,164.”

    From Mechanisms and treatment of late-life depression (2019) · cites this paper as [163]

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Research works printed but not linked: 2

  1. [46]Spitzer RL Williams JBW Gibbons M Structured Clinical Interview for Axis I DSM-IV Disorders (SCID) 1995 Washington DC Am Psych Assoc Press, Inc
  2. [52]Epping-Jordan JA Ustun TB The WHODAS-II: leveling the playing field for all disorders WHO Mental Health Bulletin 2000 6 5 6

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Authors
Alexopoulos, G. S., Raue, P. J., Kiosses, D. N., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Areán, P. A.
Affiliations
  • Weill Cornell Medicine (US)
  • University of California, San Francisco (US)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2011-01-03
Volume
68
Issue
1
Pages
33
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2010.177
PMC
PMC3018861
OpenAlex
W2002361530
Cited by
199
References
75
Citations by year
2026: 6 · 2025: 6 · 2024: 5 · 2023: 6 · 2022: 11 · 2021: 12 · 2020: 22 · 2019: 13 · 2018: 13 · 2017: 16 · 2016: 11 · 2015: 19 · 2014: 18 · 2013: 22 · 2012: 14
FWCI
20.32
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Eli Lilly and Company
  • Sanofi
  • National Institute of Mental Health (R01MH075897, P30MH085943, R01MH064099, K24MH074717, R01MH063982)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
problem-solving therapy, supportive therapy, major depressive disorder, older adults, executive dysfunction, cognitive impairment, disability, depressive symptoms, treatment-resistant depression, psychotherapy
MeSH terms
Aged, Aged, 80 and over, Cognition Disorders, Major Depressive Disorder, Disability Evaluation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Person-Centered Psychotherapy, Problem Solving, Psychotherapy, Social Support, Cognitive Behavioral Therapy, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders, Executive Function

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