The aim of this review is to examine the best available evidence to determine the effectiveness of Cognitive-Behavioural Therapy on treating depression in the elderly. The specific review question is:
What is the effectiveness of Cognitive-Behavioural Therapy on treating depression in elderly people?
The search strategy will be designed to access both published and unpublished studies in English and will comprise three stages:
1. An initial search of PsycINFO, CINAHL and Medline to identify relevant keywords contained in the title, abstract and subject descriptors.
2. Terms identified in this way, and the synonyms used by respective databases, will be used in an extensive search of the literature across all included databases.
3. Reference lists and bibliographies of all identified reports and articles will be searched for additional studies.
The time period of the search will cover articles published and unpublished from 1990 to 2011 in both the English and Thai language. Assessment for inclusion of foreign language publication will be based on the English language abstracted, when available. The database searches will include:
Current Contents Connect
Thai Nursing Research Database
Thai thesis database
Digital Library of Thailand Research Fund
Research of National Research Council of Thailand
Database of Office of Higher Education Commission
Individual search strategies will be developed for each database, adopting the different terminology of index thesauri if available. The initial search terms to be used will be Cognitive-Behavioural Therapy, depression and elderly.
Search for Grey Literature
The grey literature search will consist of conducting an online search of databases and websites including:
• Dissertation International
• Conference Proceedings
The search will be conducted to locate relevant unpublished materials, such as conference papers, research reports, and digital dissertations. Content experts will be contacted in order to provide other alternatives for securing relevant literature.
Types of study to be included
This review will consider any randomised controlled trials (RCTs) that evaluate the effectiveness of CBT on the severity of depression in the elderly. In the absence of RCTs, quasi-experimental design will be considered for possible inclusion to enable the identification of the best available evidence for reducing depression in the elderly.
Condition or domain being studied
Beck (1967) defined depression as a complex pattern of deviation of cognitive feelings and behaviour that can include a loss of interest or pleasure, depressed mood, feeling of guilt or low self-esteem, sleep or appetite disturbance, low energy and poor concentration. Depression in the elderly (people aged 60-80 years), brought about by psychosocial stress or the physiological effects of disease, can lead to: disability; cognitive impairment; suffering; family disruption; increased symptoms of medical illness; increased utilisation of health care services; and, increased rates of suicide and non-suicide mortality rates. Depression in the elderly can be diminished in severity by a number of intervention strategies, i.e. medications; individual and group psychotherapy; and, behavioural interventions, including Cognitive-Behavioural Therapy (CBT).
CBT is a structured, short-term, present-oriented psychotherapy, which has been found to help alleviate depressive symptoms by identifying a person’s automatic negative thoughts and altering their thinking, so as to bring about enduring emotional and behavioural changes. Although antidepressant drugs can be used to treat depression effectively in the elderly, the medications are usually absorbed and eliminated more slowly and produce more side effects among the elderly than among younger age groups. The strengths of CBT make it the most effective treatment for the elderly with moderate depression.
This review will consider all studies examining the treatment of older persons aged 60 years or more who had a score of 10 to 29 (mild to moderate level of depression) on the Beck Depression Inventory and were residents in a nursing home setting or in the community.
The intervention of interest to this review is Cognitive-Behavioural Therapy, which is based on cognitive theory and designed to consciously identify automatic negative thoughts and their associated problems, and to develop alternative thinking patterns and problem solving, aimed at reducing the level of depression.
The primary outcome of interest is a change in depressive symptoms. Thus, this will be defined by the relative change in scores from pre-test to post-test as measured on a standard psychological test. The severity of depression is measured by validated scales, for example, Beck Depression Inventory (BDI-IA)2. The test contains 21 items, most of which assess depressive symptoms on a Likert scale of 0-3. People are asked to report on their mood and feelings over the past week, including the day of the test.
Data extraction, (selection and coding)
Data will be extracted from papers included in the review using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
Risk of bias (quality) assessment
Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardised critical appraisal instruments for the JBI-MAStARI. The studies will be categorised according to the level of evidence presented. Any disagreements that arise between the reviewers will be resolved through discussion with a third reviewer.
Strategy for data synthesis
Where possible, odds ratio (for categorical outcome data) or standardised mean differences (for continuous data) and their 95% confidence intervals will be calculated from the data generated by each included randomised controlled trial. If appropriate, data from comparable groups of studies will be pooled into statistical meta-analysis using JBI-MAStARI. Heterogeneity between studies will be tested using the standard chi-square test.
Where statistical pooling is not appropriate or possible, the findings will be summarised in narrative form.
Analysis of subgroups or subsets
If appropriate , the findings from this systematic review will inform Joanna Briggs Institute Best Practice Information sheets, Evidence summaries and Consumer Information Sheets
Contact details for further information
Joanna Briggs Institute Synthesis Science Unit (JBI SSU)
Synthesis Science Unit (SSU)
The Joanna Briggs Institute
Faculty of Health Sciences
The University of Adelaide
Organisational affiliation of the review
Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. The Thailand Centre for Evidence-based Nursing and Midwifery: an affiliate centre of the Joanna Briggs Institute
Dr Voranut Kitsumban, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. The Thailand Centre for Evidence Based Nursing and Midwifery: an Affiliate Centre of the Joanna Briggs Institute Dr Darawan Thapinta, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. The Thailand Centre for Evidence Based Nursing and Midwifery: an Affiliate Centre of the Joanna Briggs Institute Dr Wilawan Picheansathian, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. The Thailand Centre for Evidence Based Nursing and Midwifery: an Affiliate Centre of the Joanna Briggs Institute
Anticipated or actual start date
11 January 2012
Anticipated completion date
31 January 2013
Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. The Thailand Centre for Evidence Based Nursing and Midwifery: an Affiliate Centre of the Joanna Briggs Institute
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.