PROTECT: a novel psychotherapy for late-life depression in elder abuse victims

Abstract

Elder abuse is prevalent, and victims have high rates of depression and low quality of life. We established an academic–community partnership to test the feasibility, acceptability, and impact of a brief psychotherapy for depression (PROTECT) among elder abuse victims with capacity to make decisions. Elder abuse service providers referred depressed (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) older victims (age ≥ 55 years) for potential pilot study participation. Forty eligible victims who consented were randomized to PROTECT psychotherapy (N = 25) or a Usual Care (N = 15) condition involving a community psychotherapy referral. Follow-up research assessments were conducted at 6 weeks (mid-treatment) and 9 weeks (end of treatment) after study initial assessment. We used mixed-effects regression models to examine treatment effects on depression severity and quality of life over time. Most victims (75%) reported two or more types of abuse. The a priori acceptability benchmark was met at the end of PROTECT therapy. All PROTECT participants initiated therapy; this engagement rate is greater than the a priori 75% standard set for feasibility. We found a significant reduction in depression severity (Montgomery–Åsberg Depression Rating Scale [MADRS]), with PROTECT leading to greater benefits compared to Usual Care. Both study groups had a similar improvement in quality of life. The pilot project results found that PROTECT psychotherapy is feasible, acceptable, and effective in reducing depression. With the support of our partnership, we found that PROTECT could be delivered alongside elder abuse services with victims willing to initiate therapy that leads to meaningful treatment effects.

Use of Passive Sensing in Psychotherapy Studies in Late Life: A Pilot Example, Opportunities and Challenges

“…PROTECT psychotherapy includes 9 weekly sessions, where the therapist and the client work collaboratively toward realistic goals by implementing step-by-step action plans. PROTECT has shown to reduce depression severity and increase behavioral activation among elder abuse victims [See (17); See (16) for details]. Patients' reported levels of activity during the study was measured using the Behavioral Activation for Depression Scale (BADS) (18).…”

“…In this paper, we use case study examples from the PROTECT study (16) to present the potential utility of smartphone as a data collection tool in studies of psychotherapy for late-life depression. We examined the individual fluctuations in behavioral activation levels as well as trajectories of passive sensing measures during treatment course.…”