Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial

Abstract

<b><i>Introduction:</i></b> Different psychotherapeutic interventions for late-life depression (LLD) have been proposed, but their evaluation in large, multicenter trials is rare. <b><i>Objective:</i></b> The present study evaluated the efficacy of a specific cognitive behavioral therapy (CBT) for LLD (LLD-CBT) in comparison with a supportive unspecific intervention (SUI), both administered in a specialist psychiatric outpatient setting. <b><i>Methods:</i></b> In this randomized, controlled, parallel group trial, we recruited participants (≥60 years) with moderate to severe depression at 7 trial sites in Germany. Participants were randomly assigned to the LLD-CBT or SUI group. The primary outcome was depression severity at the end of treatment measured by change on the Geriatric Depression Scale (GDS). Secondary outcomes included change in observer-rated depression, anxiety, sleep ratings, and quality of life throughout the treatment phase and at 6-month follow-up. <b><i>Results:</i></b> Between October 1, 2018, and November 11, 2020, we randomly assigned 251 patients to either LLD-CBT (<i>n</i> = 126) or SUI (<i>n</i> = 125), of whom 229 provided primary-outcome data. There was no significant between-group difference in the change in GDS scores at the end of treatment (estimated marginal mean difference: −1.01 [95% CI: −2.88 to 0.86]; <i>p</i> = 0.287). Secondary analyses showed significant improvements in several outcomes after 8 weeks and at follow-up in both treatment arms. <b><i>Conclusions:</i></b> Our data suggest that LLD-specific CBT and a supportive unspecific treatment both provide clinical benefit in patients with moderate to severe LLD without evidence for superiority of LLD-CBT.

Perceived Physical Health and Cognitive Behavioral Therapy vs Supportive Psychotherapy Outcomes in Adults With Late-Life Depression

“…In contrast, the self-rating of physical health was identified as an independent factor associated with the change in depression severity (GDS), response, and remission during LLD-CBT and SUI. High We conclude that despite the lack of statistically significant differences in the 2 treatments reported from the main analysis of this trial, 13 there are considerable subgroup interactions. The finding that LLD-CBT had a larger effect size in patients with high PPH might suggest that this group may particularly benefit from a more directive intervention, which requires concrete activities from the patients.…”

“…Previous work found that both an LLD-specific CBT (LLD-CBT) and a supportive unspecific intervention (SUI) significantly reduce depressive symptoms in LLD, without evidence of superiority of LLD-CBT . Here, we present the results of a post hoc secondary analysis of the study investigating the association of physical diseases and PPH with treatment outcome in both treatment groups.…”

“…This is a post hoc analysis of the Cognitive Behavioral Therapy for Late-Life Depression (CBTlate) trial . Details on the study design have been published previously, and the trial protocol is given in Supplement 1.…”

“…The interventions included 15 twice-weekly sessions during 8 weeks of manual-based, individual, outpatient treatment in each arm of the trial. The LLD-CBT intervention is a form of CBT with 6 modules tailored to address late-life specific psychological factors . In contrast, the active control intervention SUI uses supportive and general but nonspecific interventions.…”

“…In contrast, the active control intervention SUI uses supportive and general but nonspecific interventions. The SUI treatment sessions were unstructured, with content and process determined by the patient . All therapists were trained in both interventions and delivered either one according to individual randomization.…”