Open AccessComparing the streamlined psychotherapy “Engage” with problem-solving therapy in late-life major depression. A randomized clinical trial
Author(s) -
George S. Alexopoulos,
Patrick J. Raue,
Samprit Banerjee,
Patricia Marino,
Bren. Renn,
Nili Solomonov,
Adenike Adeagbo,
Jo Anne Sirey,
Thomas D. Hull,
Dimitris N. Kiosses,
Elizabeth Mauer,
Patricia A. Areán
Publication year - 2020
Publication title -
molecular psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.071
H-Index - 213
eISSN - 1476-5578
pISSN - 1359-4184
DOI - 10.1038/s41380-020-0832-3
Subject(s) - late life depression , depression (economics) , randomized controlled trial , psychological intervention , psychology , psychotherapist , clinical psychology , psychiatry , medicine , cognition , economics , macroeconomics
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.