Title | Comparing the streamlined psychotherapy "Engage" with problem-solving therapy in late-life major depression. A randomized clinical trial. |
Publication Type | Journal Article |
Year of Publication | 2020 |
Authors | Alexopoulos GS, Raue PJ, Banerjee S, Marino P, Renn BN, Solomonov N, Adeagbo A, Sirey JAnne, Hull TD, Kiosses DN, Mauer E, Areán PA |
Journal | Mol Psychiatry |
Date Published | 2020 Jul 01 |
ISSN | 1476-5578 |
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. |
DOI | 10.1038/s41380-020-0832-3 |
Alternate Journal | Mol Psychiatry |
PubMed ID | 32612251 |
PubMed Central ID | PMC7775269 |
Grant List | P50 MH113838 / MH / NIMH NIH HHS / United States R01 MH102304 / MH / NIMH NIH HHS / United States P50 MH115837 / MH / NIMH NIH HHS / United States T32 MH019132 / MH / NIMH NIH HHS / United States R01 MH102252 / MH / NIMH NIH HHS / United States R01 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 |