Depression and Suicidal Ideation During Two Psychosocial Treatments in Older Adults with Major Depression and Dementia

Article type: Research Article

Authors: Kiosses, Dimitris N.^{a; *} | Rosenberg, Paul B.^b | McGovern, Amanda^a | Fonzetti, Pasquale^{c; d} | Zaydens, Hana^a | Alexopoulos, George S.^a

Affiliations: [a] Department of Psychiatry, Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA | [b] Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA | [c] Department of Neurology, Weill Cornell Medical College, White Plains, NY, USA | [d] Memory Evaluation and Treatment Service (METS), Burke Rehabilitation Hospital, White Plains, NY, USA

Correspondence: [*] Correspondence to: Dimitris N. Kiosses, PhD, AssociateProfessor of Psychology in Clinical Psychiatry, Weill CornellInstitute of Geriatric Psychiatry, Weill Cornell Medical College,21 Bloomingdale Road, White Plains, NY 10605, USA. Tel.: +1 914997 4381; Fax: +1 914 682 5430; dkiosses@med.cornell.edu

Abstract: Background: Depression is prevalent in dementia and contributes to poor outcomes for patients and their families. Antidepressants have limited efficacy in older adults with major depression and dementia, and psychosocial interventions are under-investigated. Objective: To examine the course, predictors and moderators of depression and suicidal ideation during 12 weeks of home-delivered Problem Adaptation Therapy (PATH) versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in 39 older adults with major depression and dementia. Methods: Thirty-nine older adults with major depression, mild or moderate dementia, and disability participated in a randomized controlled trial that compared the efficacy of PATH versus ST-CI. Depression and suicidal ideation were assessed with Cornell Scale for Depression in Dementia Total Score and Suicide Item. Results: PATH participants had significantly greater reduction in depression than ST-CI participants over 12 weeks of treatment. PATH participants with high social support had the greatest reduction in depression. Both treatments had comparable reduction in suicidal ideation. Conclusion: PATH is more effective in reducing depression in older adults with major depression and dementia compared to ST-CI. These results are clinically significant as antidepressants have limited efficacy in this population. Home-delivered psychosocial treatments may reduce suicidal ideation in this population.

Keywords: Dementia, depression, psychosocial interventions, social support, suicidal ideation

DOI: 10.3233/JAD-150200

Journal: Journal of Alzheimer's Disease, vol. 48, no. 2, pp. 453-462, 2015