Highlights
- •What is the primary question addressed by this study? What is the state of the science on maintenance psychotherapies for depression, anxiety or both for black, Asian, and Latinx adults 60 years of age and older?
- •What is the main finding of this study? We found that maintenance psychotherapies in the treatment of depression, anxiety, or both have been under researched; and blacks, Asians, and Latinx older adults vastly underrepresented in studies. Nonetheless, the small body of knowledge signals that maintenance psychotherapies may have a role in maintaining recovery from depression.
- •What is the meaning of the finding? Despite depression and anxiety commonly and chronically affecting many older adults, maintenance psychotherapies remain under researched, greatly limiting our understanding of how to maintain the healthy functioning of older adults following recovery from these disorders.
ABSTRACT
Background/Objective
Given the chronicity of depression and anxiety disorders in late life, maintenance
treatments may have a role in preserving healthy functioning. This study aims to understand
the state of the science on maintenance psychotherapies for Black, Asian, and Latinx
older adults.
Design
Scoping review.
Methods
A priori protocol was prospectively published. Four databases were searched up to
December 1, 2021. Eligible studies were conducted in the United States or Puerto Rico
and focused on maintenance psychotherapies treating depression, anxiety, or both in
adults 60+. Due to the underrepresentation of Black, Asian, and Latinx participants,
studies were included irrespective of the participant's racial or ethnic background.
Results
A total of 3,623 unique studies were retrieved, and eight studies were included. Two
studies represented randomized clinical trials, and six were studies of post hoc analyses.
All studies were from the same research team, had similar maintenance treatments,
and focused on depression. Studies included racially homogenous samples (94-98% White).
The primary outcome was the recurrence of a major depressive episode. Across studies,
maintenance psychotherapy shows promise in preventing the recurrence of depression
in some older adults.
Conclusion
Expanding the scope of knowledge from achieving optimal functioning to sustaining
those changes in older adults is a significant public health challenge given symptom
recurrence. The small body of knowledge on maintenance psychotherapies shows a promising
direction in maintaining healthy functioning following recovery from depression. However,
opportunities remain to expand the evidence of maintenance psychotherapies with a
more significant commitment to the inclusion of diverse populations.
Key Words
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References
- Continuation and maintenance treatments for depression in older people.Cochrane Database Syst Rev. 2016; 9CD006727https://doi.org/10.1002/14651858.cd006727.pub3
- Efficacy of treatment in older depressed patients: a systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants.J Affect Disord. 2012; 141: 103-115https://doi.org/10.1016/j.jad.2012.02.036
- A randomized, controlled trial of the effectiveness of cognitive–behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults.Am J Geriatr Psychiatry. 2006; 14: 255-263https://doi.org/10.1097/01.JGP.0000196629.19634.00
- Treatment of anxiety disorders in older adults: a meta-analytic comparison of behavioral and pharmacological interventions.Am J Geriatr Psychiatry. 2007; 15: 639-651https://doi.org/10.1097/JGP.0b013e31806841c8
- Predictors of recurrence in remitted late-life depression.Depress Anxiety. 2018; 35: 658-667https://doi.org/10.1002/da.22772
- Anxiety disorders in older adults: looking to DSM5 and beyond….Am J Geriatr Psychiatry. 2013; 21: 872-876https://doi.org/10.1016/j.jagp.2013.01.011
- Anxiety disorders: new developments in old age.Am J Geriatr Psychiatry. 2011; 19: 301-304https://doi.org/10.1097/jgp.0b013e31820db34f
- Predictors of relapse and recurrence following cognitive behavioural therapy for anxiety-related disorders: a systematic review.Cogn Behav Ther. 2021; 50: 1-18https://doi.org/10.1080/16506073.2020.1812709
- The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization.Am J Geriatr Psychiatry. 2009; 17: 473-482https://doi.org/10.1097/jgp.0b013e31819b87b2
- Depression and mortality in a longitudinal study: 1952-2011.Cmaj. 2017; 189: E1304-e1310https://doi.org/10.1503/cmaj.170125
- Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder.Am J Geriatr Psychiatry. 2005; 13: 77-80https://doi.org/10.1097/00019442-200501000-00011
- Continuing treatment of depression in the elderly: a systematic review and meta-analysis of double-blinded randomized controlled trials with antidepressants.Am J Geriatr Psychiatry. 2011; 19: 249-255https://doi.org/10.1097/JGP.0b013e3181ec8085
- Management of depression in older adults: a review.JAMA. 2017; 317: 2114https://doi.org/10.1001/jama.2017.5706
American Psychological Association. Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts. 2019. Available at: https://www.apa.org/depression-guideline. Accessed October 3, 2022.
- Patients’ depression treatment preferences and initiation, adherence, and outcome: a randomized primary case study.Psychiatric Serv. 2009; 60: 337-343https://doi.org/10.1176/ps.2009.60.3.337
JS Passel and D Cohn, U.S. Population Projections: 2005-2050, 2008, Pew Research Center. Available at: http://www.pewhispanic.org/2008/02/11/us-population-projections-2005-2050. Accessed October 3, 2022.
- High occurrence of mood and anxiety disorders among older adults.Arch Gen Psychiatry. 2010; 67: 489https://doi.org/10.1001/archgenpsychiatry.2010.35
- Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication.Am J Geriatr Psychiatry. 2009; 17: 769-781https://doi.org/10.1097/JGP.0b013e3181ad4f5a
Jiménez AL, Cruz-Gonzalez M, Calhoun TF, et al. Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S. Cult Divers Ethnic Minority Psychol. Published online February 3, 2022. doi:10.1037/cdp0000524
- PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation.Ann Intern Med. 2018; 169: 467-473https://doi.org/10.7326/m18-0850
- Chapter 11: Scoping Reviews (2020 version).in: Aromataris E Munn Z JBI Manual for Evidence Synthesis. JBI, 2020https://doi.org/10.46658/JBIMES-20-12
- Mental Health Continuation and Maintenance Interventions administered after mental health interventions for anxiety or depression in minority older adults: a scoping review.Open Sci Framew. 2021; (Published online November 25)https://doi.org/10.17605/OSF.IO/VAXUW
Medical Library Association Latinx Cacus. Latinx/Hispanic US Population Search Hedges. 2021. Available at: https://scholarshare.temple.edu/handle/20.500.12613/6949. Accessed October 3, 2022.
- Continuation and maintenance treatments for depressive disorder in older adults.Cochrane Database Syst Rev. 2007; https://doi.org/10.1002/14651858.CD006727
EndNote [Computer Software]. Version EndNote X9. Philadelphia, PA: Clarivate. 2013. Available at: https://endnote.com/. Accessed December 1, 2021.
Covidence systematic review software [Computer Software]. Melbourne, Australia: Veritas Health Innovation. Available at: https://www.covidence.org/. Accessed December 2, 2021.
- Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years.JAMA. 1999; 281: 39https://doi.org/10.1001/jama.281.1.39
Miller M, Frank E, Cornes C, et al. The value of maintenance interpersonal psychotherapy (IPT) in older adults with different IPT foci. Am J Geriatr Psychiatry. 11:97-102
- Treatment of 70+-year-olds with recurrent major depression: excellent short-term but brittle long-term response.Am J Geriatr Psychiatry. 1999; 7: 64-69https://doi.org/10.1097/00019442-199924710-00009
- Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: effects on social adjustment.AJP. 2002; 159: 466-468https://doi.org/10.1176/appi.ajp.159.3.466
- Initial recovery patterns may predict which maintenance therapies for depression will keep older adults well.J Affect Disord. 2001; 65: 155-166https://doi.org/10.1016/S0165-0327(00)00280-9
- Maintenance treatment of major depression in old age.N Engl J Med. 2006; 354: 1130-1138https://doi.org/10.1056/NEJMoa052619
- Maintenance treatment for old-age depression preserves health-related quality of life: a randomized, controlled trial of paroxetine and interpersonal psychotherapy.J Am Geriatr Soc. 2007; 55: 1325-1332https://doi.org/10.1111/j.1532-5415.2007.01292.x
- A controlled evaluation of monthly maintenance interpersonal psychotherapy in late-life depression with varying levels of cognitive function.Int J Geriat Psychiatry. 2008; 23: 1110-1113https://doi.org/10.1002/gps.2031
- Structured Clinical Interview for DSM-IV Axis I Disorders: SCID-I: Clinical Version: Scoresheet.American Psychiatric Press, Washington DC1997 (Published online)
- A lifespan view of anxiety disorders.Dialog Clin Neurosci. 2011; 13: 381-399
- Benzodiazepine use in the United States.JAMA Psychiatry. 2015; 72: 136https://doi.org/10.1001/jamapsychiatry.2014.1763
Article info
Publication history
Published online: February 12, 2023
Accepted:
February 3,
2023
Received in revised form:
February 2,
2023
Received:
October 14,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
