Depression in later life: a review of the effectiveness and efficiency of psychological therapies and an empirical exploration of the predictors of attitudes to seeking psychological help and recognition of depression.
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Background: Depression within the older adult population is common. Previous reviews of the literature have considered the efficacy of psychological therapies for older adults. However, they have exclusively focussed on evidence provided by randomised controlled trials neglecting emergent evidence from other therapeutic modalities. Despite the efficacy of psychological and pharmacological treatments many depressed older people go without treatment. The barriers to treatment remain unclear, however the literature has previously suggested that they may fall within three factors; patients, health care providers and health care organisations. This study focussed on patient related factors. The literature has suggested that older adults not be as accurate in recognising symptoms of depression than adults of working age. In turn, lack of recognition of the presence of a mental health problem may influence older adult’s attitudes to seeking psychological help. The literature suggests a number of factors may influence treatment seeking attitudes in older people. These may include accuracy of depression recognition, cognitive fusion; engagement in valued activities although these did not appear to have previously been considered. Aims: The aims of this thesis were addressed by the systematic review of the literature and empirical research paper comprising it. Systematic review aimed, in light of a recent efficiency target issued by the The Scottish Government to update the literature relating to the efficacy of standalone psychological therapies for older adults and to consider the efficiency implications of the results. The empirical article had two overall aims. It sought to determine the predictive effect of attitudes to ageing and degree of depression on older adult’s ability to conceptualise their symptoms of psychological distress as depression. This study also sought to consider, in light of a paucity of empirical evidence to date, the relative predictive effect of attitudes to ageing, depression, recognition of depression symptoms, cognitive fusion and engagement in valued activities on the treatment seeking attitudes of a cohort of depressed older adults. Method: A systematic review of the literature was undertaken to consider the efficacy and efficiency of psychological therapies in the treatment of late life depression. An empirical cross sectional survey recruiting older adults (n = 281), aged ≥ 65 years was undertaken to examine the effects of depression, cognitive fusion, attitudes to ageing, and valued behaviour on attitudes to seeking professional psychological help. Results: In the systematic review, of the 1493 articles identified 11 were retained for review. Papers reviewed considered the effectiveness psychological interventions including: Cognitive Behavioural Therapies, Reminiscence Therapies, Acceptance and Commitment Therapy and Problem Solving Therapy. The results of the statistical analysis in the empirical work suggested that a significant proportion of ‘depressed’ older adults (n = 43) recruited to our study were not able to recognise they were depressed at the time of their participation in the study. A binomial logistic regression suggested that depression severity rather than attitudes to ageing predicted depression recognition in this sample. A hierarchical multiple regression undertaken to analyse the predictive influence of depression, depression recognition, cognitive fusion, attitudes to ageing and engagement in valued activities suggested that non of these variables significantly predicted our sample’s attitudes to seeking professional psychological help. Conclusions: Our results demonstrate that there is increasing evidence that some psychological therapies could be offered as alternatives to antidepressant medication for older people and within an efficient model of stepped care. The results of the empirical element of this project suggest that attitudes to ageing and cognitive fusion are both predictors of attitudes to treatment seeking. The results further suggest that many depressed older people don’t recognise when they are depressed suggesting a lack of mental health. These findings suggest several implications for clinical practice, psychological therapies and public health.