Addressing depression in a long-term care setting: a Phase II pilot of problem-solving treatment
Open accessAbstract
Purpose This was a Phase II pilot study of a problem-solving treatment (PST) to address subsyndromal depression in residents of long-term care facilities. Our goal was to demonstrate PST implementation feasibility and to identify PST's potential for reducing depressive symptoms in this geriatric health care setting.Methods Eligible participants were randomized to receive a PST treatment (six 1-hour sessions) or a social contact comparison (6 "friendly" visits) after an initial baseline assessment. Follow-up assessments occurred 7 weeks later (after treatment) and 2 months posttreatment. The basic analytic approach was based on an intention-to-treat analysis.Findings We enrolled 21 elderly subjects in the PST group and 16 elderly subjects in the social contact comparison group. The PST group experienced a decline in depression scores compared with the social contact group. Although not statistically significant (likely due to the small sample size), PST was associated with decreased depressive symptom scores for those who were able to complete the intervention. Implementation proved to be difficult in terms of study recruitment and intervention acceptance and adherence.Implications These study findings point to the potential benefits of an integrated mental health component in long-term care, involving rehabilitation professionals who are already working with the older adults in both postacute/short-stay and long-stay settings.
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Non-specific attentional control conditions provided attention or activities matched in duration and frequency to the intervention, while excluding therapeutic techniques; examples included friendly visits and social discussion or education groups.
“Non-specific attentional control refers to conditions in which participants were provided with attention from researchers, facility staff, or volunteers, or were engaged to participate in activities.The duration and frequency of such activities matched those of the intervention condition.The control condition simulated the attention received by participants in the intervention condition, while”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFour studies were at low risk of selection bias for random sequence generation and allocation concealment.
“Four studies were at low risk of selection bias (random sequence generation and allocation concealment; Dozeman 2011; Reinhardt 2014; Travers 2017; Tsai 2008)”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
The Measurement section says participants were randomized to problem-solving treatment or social contact. It does not describe how the random sequence was generated or whether allocation was concealed, so our copy does not establish the claimed low risk of selection bias for Reinhardt 2014. It cannot substantiate the assessment of the other three studies. (LLM, conf=0.83)
Experimental — accuracy not yet measuredInterpretation of the treatment non-acceptability result requires caution because of inadequate reporting and potential unreliability, with very wide confidence intervals.
“Interpretation of the result for treatment non-acceptability requires particular caution due to inadequate reporting of this outcome and potential unreliability of the estimate, with very wide CIs for ORs (e.g.0.47 to 202.37 for Hamzehzadeh 2018, and 0.30 to 130.07 for Reinhardt 2014).”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
The Results (page not available) report difficulties with treatment acceptance and adherence, including loss to follow-up of 10/21 participants in the treatment group versus 1/16 in the comparison group. The paper also notes its small sample, but it does not report an odds ratio, the stated confidence interval of 0.30 to 130.07, or an assessment of that estimate's reliability. Those parts of the caution appear to be the citing authors' analysis rather than results reported by Reinhardt et al. (LLM, conf=0.84)
Experimental — accuracy not yet measuredReinhardt 2014 was judged at unclear risk of reporting bias.
“Selective reporting (reporting bias) Unclear risk Judgement comment: no protocol or trial registration identified. 2 outcomes listed in the methods (HAM-D and PROMIS depression scale) were reported in the results.The SCID was listed in the methods, but diagnostic data were not reported in the results.However, it is unclear whether the SCID was intended as a screening measure only.”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
The Statistical Approach names HAM-D and PROMIS depression as primary outcomes, the Results report both, and Procedures and Measures says the SCID was used to confirm diagnoses. The paper does not itself judge its reporting-bias risk as unclear; that is the citing authors’ assessment. Our copy also does not establish whether a protocol or trial registration was identified. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn nine studies, psychological therapies were delivered by specialists; in five, by graduate or doctoral students; both were classified as professional therapists.
“In nine studies, psychological therapies were delivered by specialists, including social workers (Dhooper 1993; Luo 2020; Reinhardt 2014; Travers 2017), a mental health consultant (Meeks 2008), a clinical nurse specialist (Abraham 1992), a Masters level therapist (Karimi 2010), a Masters-prepared mental health nurse (Tsai 2008), and unspecified 'therapist' (Hyer 2009).In five studies, treatments”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
Five studies restricted eligibility to participants meeting defined diagnostic criteria for a mood disorder, typically MDD, minor depression, and dysthymia, plus adjustment disorder with depression.
“Five studies restricted eligibility to participants who met defined diagnostic criteria for a mood disorder, which typically included MDD, 'minor depression', and dysthymia (Meeks 2008;Meeks 2015;Reinhardt 2014;Rosen 1997), in addition to adjustment disorder with depression (Hyer 2009).”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
Four studies excluded participants with more severe depression; one excluded those meeting DSM-IV criteria for a depressive or anxiety disorder, and three excluded those with severe symptoms.
“In contrast, four studies excluded participants with more-severe depression.One study focusing on subthreshold depression excluded participants who met DSM-IV criteria for a depressive or anxiety disorder (Dozeman 2011), while three studies excluded participants with a severe level of symptoms (Dhooper 1993;Reinhardt 2014;Rosen 1997), as indicated by a high score on a depression rating scale or”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
For Reinhardt 2014, two outcomes listed in the methods (HAM-D and PROMIS depression scale) were reported in the results.
“2 outcomes listed in the methods (HAM-D and PROMIS depression scale) were reported in the results”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
For Reinhardt 2014, the sample may not have been homogeneous.
“sample may not have been homogeneous”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
For Reinhardt 2014, it is unclear whether the SCID was intended as a screening measure only.
“it is unclear whether the SCID was intended as a screening measure only”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
For Reinhardt 2014, the SCID was listed in the methods but diagnostic data were not reported in the results.
“The SCID was listed in the methods, but diagnostic data were not reported in the results”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
For Reinhardt 2014, the sample consisted of two potentially different groups of nursing home residents.
“study sample … was composed of 2 potentially different groups of nursing home residents”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
For Reinhardt 2014, researcher allegiance to the intervention could not be determined.
“Researcher allegiance to the intervention could not be determined”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
The Contribution section describes the authors’ roles, and the Conflict section reports no conflicts of interest, but neither addresses researcher allegiance to problem-solving treatment. The Intervention section describes who delivered and supervised treatment without establishing the researchers’ allegiance. Our copy therefore does not verify the citing document’s assessment that allegiance could not be determined. (LLM, conf=0.72)
Experimental — accuracy not yet measuredFor Reinhardt 2014, it was unclear if treatment fidelity was assessed.
“Unclear if treatment fidelity was assessed”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
The Intervention section (page unavailable) says the PST therapist was trained and supervised, but does not say whether treatment fidelity was assessed. Searches for fidelity assessment, monitoring, and quality of delivery found no passage that resolves whether an assessment occurred. (LLM, conf=0.70)
Experimental — accuracy not yet measuredFor Reinhardt 2014, no protocol or trial registration was identified.
“no protocol or trial registration identified”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Reinhardt 2014
The Patients and Methods section describes the study procedures, and the Results section mentions adherence to the intervention protocol, but neither addresses whether a separate study protocol or trial registration was identified. Searches for trial registration, a registry identifier, and a published study protocol found no decisive passage in our copy; absence of a mention does not establish the claim. (LLM, conf=0.70)
Experimental — accuracy not yet measured
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- Authors
- Reinhardt, J. P., Horowitz, A., Cimarolli, V. R., Eimicke, J. P., & Teresi, J. A.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Fordham University (US)
- Hebrew Home (US)
- Corresponding author
- Reinhardt, Joann P.
- Venue
- Clinical Therapeutics
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 36
- Issue
- 11
- Pages
- 1531-1537
- ISSN
- 0149-2918 (ISSN-L)
- OpenAlex
- W2126765939
- Cited by
- 18
- References
- 17
- Citations by year
- 2024: 1 · 2023: 4 · 2022: 2 · 2021: 1 · 2020: 3 · 2018: 1 · 2016: 3 · 2015: 1 · 2014: 2
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mount Sinai School of Medicine Claude D. Pepper Older Americans Center on “Promoting Independence through Pain and Symptom Management” (1P30AG028741-01A2)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- problem-solving therapy, subthreshold depression, long-term care residents, older adults, depressive symptoms, implementation feasibility, integrated mental health services, rehabilitation professionals, geriatric mental health
- MeSH terms
- Aged, Aged, 80 and over, Depression, Female, Humans, Long-Term Care, Male, Middle Aged, Pilot Projects, Problem Solving, Social Support
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