The Management of Depression and Anxiety in Older People: Evidence-Based Psychological Interventions, Stepped Care and Collaborative Care

Purpose: This report updates the Cancer Care Ontario Program in Evidence-Based Care guideline for the management of depression in adult patients with cancer. This guideline covers pharmacologic, psychological, and collaborative care interventions, with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer. Methods: Recommendations were developed by synthesizing information from extant guidelines and reviews and searching for randomized controlled trials from the date of database inception (1964 for MEDLINE and 1974 for EMBASE) to January 2015. Quality assessment of guidelines and systematic reviews were conducted by using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), Assessment of Multiple Systematic Reviews (AMSTAR), and Cochrane Risk of Bias tools. Final recommendations were developed through a standardized Program in Evidence-Based Care multidisciplinary expert and knowledge user review process. Results: Two high-quality relevant clinical practice guidelines, eight pharmacologic trials, nine psychological trials, and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed. Eight specific recommendations were made to establish a standard of care for the management of depression in patients with cancer. The recommendations and practical management tools were reviewed as being well organized and helpful, although systemic barriers to implementation were identified. Conclusion: This updated guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and/or pharmacologic interventions, without evidence for the superiority of any specific treatment over another. New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression.

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Is Cognitive Behavioural Therapy focusing on Depression and Anxiety Effective for People with Long-Term Physical Health Conditions? A Controlled Trial in the Context of Type 2 Diabetes Mellitus

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465817000492 ◽

2017 ◽

Vol 46 (2) ◽

pp. 129-147 ◽

Cited By ~ 5

Author(s):

Abigail L. Wroe ◽

Edward W. Rennie ◽

S. Sollesse ◽

J. Chapman ◽

A. Hassy

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Treatment Condition ◽

Specific Treatment ◽

Health Conditions ◽

Psychological Interventions ◽

Evidence Based ◽

Depression And Anxiety

Background: It is unclear as to the extent to which psychological interventions focusing specifically on depression and anxiety are helpful for people with physical health conditions, with respect to mood and condition management. Aims: To evaluate the effectiveness of a modified evidence-based psychological intervention focusing on depression and anxiety for people with type 2 diabetes mellitus (T2DM), compared with a control intervention. Method: Clients (n = 140) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM were allocated to either diabetes specific treatment condition (n = 52) or standard intervention (control condition, n = 63), which were run in parallel. Each condition received a group intervention offering evidence-based psychological interventions for people with depression and anxiety. Those running the diabetes specific treatment group received additional training and supervision on working with people with T2DM from a clinical health psychologist and a general practitioner. The diabetes specific treatment intervention helped patients to link mood with management of T2DM. Results: Both conditions demonstrated improvements in primary outcomes of mood and secondary outcome of adjustment [95% confidence interval (CI) between 0.25 and 5.06; p < 0.05 in all cases]. The diabetes specific treatment condition also demonstrated improvements in secondary outcomes of self-report management of T2DM for diet, checking blood and checking feet, compared with the control condition (95% CIs between 0.04 and 2.05; p < 0.05 in all cases) and in glycaemic control (95% CI: 0.67 to 8.22). The findings also suggested a non-significant reduction in NHS resources in the diabetes specific treatment condition. These changes appeared to be maintained in the diabetes specific treatment condition. Conclusions: It is concluded that a modified intervention, with input from specialist services, may offer additional benefits in terms of improved diabetic self-management and tighter glycaemic control.

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Dissemination and Implementation of Evidence-Based Psychological Interventions

10.1093/med:psych/9780195389050.003.0013 ◽

2015 ◽

Author(s):

R. Kathryn McHugh ◽

David H. Barlow

Keyword(s):

Stepped Care ◽

Current Status ◽

Psychological Interventions ◽

Dissemination And Implementation ◽

Evidence Based ◽

Future Directions ◽

Research And Practice ◽

Dissemination And Implementation Science ◽

Care Models ◽

Standardization Of Procedures

Chapter 13 explores the current status of research and future directions for the dissemination and implementation of evidence-based psychological interventions, including further emphasis on dissemination and implementation science, standardization of procedures for outcomes assessment, better collaboration between research and practice, transdiagnostic treatments, stepped-care models, integration of mental health care in primary care, and use of information technology.

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Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial

BMJ ◽

10.1136/bmj.h6127 ◽

2015 ◽

pp. h6127 ◽

Cited By ~ 24

Author(s):

Hilde P A van der Aa ◽

Ger H M B van Rens ◽

Hannie C Comijs ◽

Tom H Margrain ◽

Francisca Gallindo-Garre ◽

...

Keyword(s):

Older Adults ◽

Randomised Controlled Trial ◽

Visually Impaired ◽

Controlled Trial ◽

Stepped Care ◽

Depression And Anxiety ◽

Randomised Controlled

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Reframing Aging in Contemporary Politics: Building Momentum

Innovation in Aging ◽

10.1093/geroni/igaa057.2370 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 681-681

Author(s):

Patricia D'Antonio

Keyword(s):

Social Change ◽

Older People ◽

Evidence Based ◽

Negative Attitudes ◽

Attitudes And Behaviors ◽

Contemporary Politics ◽

Perceptions Of Aging ◽

The Many ◽

Changing Attitudes

Abstract Changing American culture is challenging and changing attitudes and behaviors around the universal experience of aging especially so. Unless the field of advocates who care about aging issues cultivates a more visible, more informed conversation on older people, it will remain difficult to advance the systemic changes needed to adjust to a society with increased and increasing longevity. Advocates will need to be vigilant to avoid cueing negative attitudes towards aging and aging policies. The Reframing Aging Initiative is a long-term, social change endeavor designed to improve the public’s understanding of what aging means and the many contributions older people bring to society. Using evidence-based research, the initiative seeks to teach advocates how to tell an effective story about aging that will promote positive perceptions of aging and reduce ageism. The time to change the conversation is now.

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Service Use, Drop-Out Rate and Clinical Outcomes: A Comparison Between High and Low Intensity Treatments in an IAPT Service

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813000544 ◽

2014 ◽

Vol 42 (6) ◽

pp. 747-759 ◽

Cited By ~ 16

Author(s):

Stella W. Y. Chan ◽

Malcolm Adams

Keyword(s):

Clinical Outcomes ◽

High Intensity ◽

Recovery Rate ◽

Service Use ◽

Evaluation Study ◽

Drop Out ◽

Stepped Care ◽

Depression And Anxiety ◽

Low Intensity ◽

Drop Out Rate

Background: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher “step-up” rates between low and high intensity treatments. Aims: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. Method: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. Results: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. Conclusions: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.

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Positive psychology: resilience and its role within mental health nursing

British Journal of Mental Health Nursing ◽

10.12968/bjmh.2020.0049 ◽

2021 ◽

Vol 10 (1) ◽

pp. 1-14

Author(s):

Jan Macfarlane

Keyword(s):

Mental Health ◽

Positive Psychology ◽

Psychological Interventions ◽

Evidence Based ◽

Mental Health Nursing ◽

Mental Health Workforce ◽

Positive Psychological Interventions ◽

Health Nursing ◽

The Individual ◽

User Friendly

This is the ninth article in a series that explores the meaning of positive psychology and the importance it has on the wellbeing of the mental health workforce. It will focus on positive psychology interventions that help to develop resilience and to consider how the uplifting effect of resilience through contemporary use in the field of mental health nursing can be experienced. This article will explain what the term resilience means and how it is embedded in the practice of positive psychological interventions. Finally, it will emphasise how the application of positive psychological interventions can benefit the individual and the organisation. The practical tasks provided in the boxes throughout the article will help the reader identify what resilience means for them and understand how to further develop its transferability through evidence-based, user-friendly exercises.

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