Examining the feasibility and effectiveness of case manager delivered problem-solving therapy on late-life depression in a real-world setting: a mixed design pilot study

Abstract

To optimize outcomes in Late-Life Depression (LLD), there remains a need for innovative augmentation treatments. Problem-Solving Therapy (PST) is demonstrated as an effective augmentation psychotherapy for LLD in a one-to-one setting. This study investigated the feasibility of implementing Case Manager delivered group PST for LLD in a community setting. The design was a mixed-methods pilot one-group pre-test post-test quasi-experimental feasibility study in adults aged 60+ years meeting criteria for major depressive disorder (MDD). Feasibility measures were inclusion, attendance, and attrition rate. PST was delivered in groups of 6–9 participants over 8 weeks. Participants completed a weekly self-rated depression scale from weeks 1–8, and pre-and post-intervention rater assessed depression and self-rated assessments of quality of life, insomnia, disability, and anxiety. Focus group interviews took place at week 8 for the first and last study cohort. Twenty-nine participants (inclusion rate of 91%) were enrolled, a recruitment rate of 2.2 participants/month. Of these, 26 (90%) completed week 8 assessments and 25 (96%) attended 5 or more PST sessions, while 15 (58%) attended all sessions. Self-rated depression, anxiety, and insomnia scores decreased significantly with medium-to-large effect sizes, while there was non-significant improvement in rater-assessed depression and self-rated disability and quality of life. Qualitative data showed participants found PST an easy-to-use technique and felt empowered and hopeful in recovering from depression. The results justify a replication of the study in a large RCT exploring the efficacy of offering a group-based Case Manager facilitated PST to older adults with LLD, in a community setting. Clinical Trial Registration Number: NCT03408821.