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Comparing the streamlined psychotherapy "Engage" with problem-solving therapy in late-life major depression. A randomized clinical trial.

TitleComparing the streamlined psychotherapy "Engage" with problem-solving therapy in late-life major depression. A randomized clinical trial.
Publication TypeJournal Article
Year of Publication2020
AuthorsAlexopoulos GS, Raue PJ, Banerjee S, Marino P, Renn BN, Solomonov N, Adeagbo A, Sirey JAnne, Hull TD, Kiosses DN, Mauer E, Areán PA
JournalMol Psychiatry
Date Published2020 Jul 01
ISSN1476-5578
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.

DOI10.1038/s41380-020-0832-3
Alternate JournalMol. Psychiatry
PubMed ID32612251
Grant ListR01 MH102252 / MH / NIMH NIH HHS / United States
T32 MH019132 / MH / NIMH NIH HHS / United States
P50 MH113838 / MH / NIMH NIH HHS / United States
R01 MH102304 / MH / NIMH NIH HHS / United States
P50 MH115837 / MH / NIMH NIH HHS / United States
Division: 
Biostatistics
Category: 
Faculty Publication