Older adults respond better to psychological therapy than working-age adults: evidence from a large sample of mental health service attendees.
Anxiety disorders
Community mental health services
Depressive disorder
Geriatric psychiatry
Psychological therapy
Psychotherapy outcome research
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 11 2021
01 11 2021
Historique:
received:
19
01
2021
revised:
29
06
2021
accepted:
30
06
2021
pubmed:
19
7
2021
medline:
29
10
2021
entrez:
18
7
2021
Statut:
ppublish
Résumé
Older adults commonly experience depression and anxiety, yet are under-represented in psychological treatment services. There is uncertainty about the outcomes from psychological therapies for older adults relative to working-age adults. This study explored: pre-treatment differences between older and working-age patients with depression or anxiety disorders; whether outcomes from psychological therapy differ between groups controlling for pre-treatment clinical severity, functioning, and socio-demographics; and whether the impact of a long-term health condition (LTC) on outcome differs by age. Data on >100,000 patients treated with psychological therapies in eight Improving Access to Psychological Therapies services were analyzed. We compared pre-treatment characteristics and therapy outcomes for older (≥65 years) and working-age (18-64 years) patients, and investigated associations between age and outcomes. Older adults had less severe clinical presentations pre-treatment. In adjusted models older adults were more likely to reliably recover (OR=1.33(95%CI=1.24-1.43)), reliably improve (OR=1.34(95%CI =1.24-1.45)), and attrition was less likely (OR=0.48(95%CI =0.43-0.53)). Effects were more pronounced in patients with anxiety disorders compared to depression. Having an LTC was associated with a much lower likelihood of reliable recovery for working-age patients but had only a modest effect for older adults. There are potential selection biases affecting the characteristics of older people attending these services. Residual confounding cannot be ruled out due to limits on data available. Older adults experienced better outcomes from psychological treatments than working-age adults. Given the deleterious effects if mental health conditions go untreated, increasing access to psychological therapies for older people should be an international priority.
Sections du résumé
BACKGROUND
Older adults commonly experience depression and anxiety, yet are under-represented in psychological treatment services. There is uncertainty about the outcomes from psychological therapies for older adults relative to working-age adults. This study explored: pre-treatment differences between older and working-age patients with depression or anxiety disorders; whether outcomes from psychological therapy differ between groups controlling for pre-treatment clinical severity, functioning, and socio-demographics; and whether the impact of a long-term health condition (LTC) on outcome differs by age.
METHODS
Data on >100,000 patients treated with psychological therapies in eight Improving Access to Psychological Therapies services were analyzed. We compared pre-treatment characteristics and therapy outcomes for older (≥65 years) and working-age (18-64 years) patients, and investigated associations between age and outcomes.
RESULTS
Older adults had less severe clinical presentations pre-treatment. In adjusted models older adults were more likely to reliably recover (OR=1.33(95%CI=1.24-1.43)), reliably improve (OR=1.34(95%CI =1.24-1.45)), and attrition was less likely (OR=0.48(95%CI =0.43-0.53)). Effects were more pronounced in patients with anxiety disorders compared to depression. Having an LTC was associated with a much lower likelihood of reliable recovery for working-age patients but had only a modest effect for older adults.
LIMITATIONS
There are potential selection biases affecting the characteristics of older people attending these services. Residual confounding cannot be ruled out due to limits on data available.
CONCLUSIONS
Older adults experienced better outcomes from psychological treatments than working-age adults. Given the deleterious effects if mental health conditions go untreated, increasing access to psychological therapies for older people should be an international priority.
Identifiants
pubmed: 34274792
pii: S0165-0327(21)00672-8
doi: 10.1016/j.jad.2021.06.084
pmc: PMC8411661
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
85-93Subventions
Organisme : Wellcome Trust
ID : 201292/Z/16/Z
Pays : United Kingdom
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
Copyright © 2021. Published by Elsevier B.V.
Références
Nat Rev Neurol. 2011 May 03;7(6):323-31
pubmed: 21537355
Am J Psychiatry. 2002 Mar;159(3):469-73
pubmed: 11870014
J Nerv Ment Dis. 2006 Apr;194(4):287-93
pubmed: 16614551
Am J Geriatr Psychiatry. 2018 Jan;26(1):107-122
pubmed: 28735658
Cogn Behav Ther. 2018 Mar;47(2):91-106
pubmed: 29345530
J Clin Psychiatry. 2013 Jun;74(6):595-602
pubmed: 23842011
Acta Psychiatr Scand. 2006 May;113(5):372-87
pubmed: 16603029
PLoS One. 2014 Jan 08;9(1):e83875
pubmed: 24416178
Int J Geriatr Psychiatry. 2001 Jun;16(6):622-30
pubmed: 11424172
Cogn Behav Therap. 2020 Jun 09;13:e16
pubmed: 33613689
Psychother Psychosom. 2016;85(3):136-45
pubmed: 27043240
BJPsych Open. 2018 Oct 02;4(5):411-418
pubmed: 30294451
BMJ Open. 2019 May 14;9(5):e027663
pubmed: 31092665
Epidemiol Psychiatr Sci. 2021 Jun 04;30:e42
pubmed: 34085616
BMJ Qual Improv Rep. 2016 Aug 11;5(1):
pubmed: 27559469
Lancet. 2005 Jan 8-14;365(9454):176-86
pubmed: 15639301
J Public Health (Oxf). 2018 Sep 1;40(3):e375-e387
pubmed: 29253218
Med Care. 2001 Aug;39(8):772-84
pubmed: 11468497
Psychother Psychosom. 2017;86(1):13-30
pubmed: 27884006
J Affect Disord. 2019 Apr 15;249:327-335
pubmed: 30802698
BMJ. 2017 Mar 3;356:j573
pubmed: 28258124
World Psychiatry. 2020 Feb;19(1):92-107
pubmed: 31922679
J Clin Psychiatry. 2017 Apr;78(4):e363-e371
pubmed: 28448697
Lancet. 2018 Feb 17;391(10121):679-686
pubmed: 29224931
J Am Geriatr Soc. 2012 Feb;60(2):218-29
pubmed: 22283717
J Am Geriatr Soc. 2011 Jul;59(7):1197-205
pubmed: 21718261
Int Psychogeriatr. 2000 Mar;12(1):15-33
pubmed: 10798451
Psychol Med. 2021 May;51(7):1068-1081
pubmed: 33849685
Multivariate Behav Res. 2011 May;46(3):399-424
pubmed: 21818162
Clin Psychol Rev. 2018 Aug;64:13-38
pubmed: 30075313
Psychother Psychosom. 2016;85(5):270-88
pubmed: 27508501
JAMA. 2009 Apr 8;301(14):1460-7
pubmed: 19351943
Annu Rev Clin Psychol. 2018 May 7;14:159-183
pubmed: 29350997
Psychother Psychosom. 2015;84(1):22-9
pubmed: 25547421
J Neurol Neurosurg Psychiatry. 2021 Feb;92(2):158-164
pubmed: 33268471