Comparing the streamlined psychotherapy "Engage" with problem-solving therapy in late-life major depression. A randomized clinical trial.
| Publication Type | Academic Article |
| Authors | Alexopoulos G, Raue P, Banerjee S, Marino P, Renn B, Solomonov N, Adeagbo A, Sirey J, Hull T, Kiosses D, Mauer E, Areán P |
| Journal | Mol Psychiatry |
| Volume | 26 |
| Issue | 9 |
| Pagination | 5180-5189 |
| Date Published | 07/01/2020 |
| ISSN | 1476-5578 |
| Keywords | Depressive Disorder, Major |
| Abstract | Effective psychotherapies for late-life depression are underutilized, mainly because of their complexity. "Engage" is a novel, streamlined psychotherapy that relies on neurobiology to identify core behavioral pathology of late-life depression and targets it with simple interventions, co-designed with community therapists so that they can be delivered in community settings. Consecutively recruited adults (≥60 years) with major depression (n = 249) were randomly assigned to 9 weekly sessions of "Engage" or to the evidence-based Problem-Solving Therapy (PST) offered by 35 trained community social workers and assessed by blind raters. "Engage" therapists required an average of 30% less training time to achieve fidelity to treatment than PST therapists and had one-third of the PST therapists' skill drift. Both treatments led to reduction of HAM-D scores over 9 weeks. The mixed effects model-estimated HAM-D ratings were not significantly different between the two treatments at any assessment point of the trial. The one-sided 95% CI for treatment-end difference was (-∞, 0.07) HAM-D points, indicating a non-inferiority margin of 1.3 HAM-D points or greater; this margin is lower than the pre-determined 2.2-point margin. The two treatment arms had similar response (HR = 1.08, 95% CI (0.76, 1.52), p = 0.67) and remission rates (HR = 0.89, 95% CI (0.57, 1.39), p = 0.61). We conclude that "Engage" is non-inferior to PST. If disseminated, "Engage" will increase the number of therapists who can reliably treat late-life depression and make effective psychotherapy available to large numbers of depressed older adults. |
| DOI | 10.1038/s41380-020-0832-3 |
| PubMed ID | 32612251 |
| PubMed Central ID | PMC7775269 |