EFFECTIVENESS OF NURSE-LED PSYCHOTHERAPY IN IMPROVING DEPRESSIVE SYMPTOMS AND QUALITY OF LIFE OF OLDER ADULTS IN THE COMMUNITY WITH DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Depression is one of the most common mental illnesses suffered by older adults. Common treatments include psychotherapy and antidepressants, which the latter can have numerous detrimental effects. Depression in older adults follows a chronic course and it has been shown that most of them seek treatment in primary care settings. Nurses play an important role in providing such mental health-care treatment in the community. Aims: This review aimed to synthesise the best evidence regarding the effectiveness of nurse-led interventions used in the community for older adults with depression. Selection Criteria: Studies were included if: 1) Psychotherapy were conducted by nurses, 2) Participants were 60 years or above with clinically diagnosed depression 3) Were available in English. 4) Had a randomised controlled trial (RCT) or controlled clinical trial (CCT) design, 5) Used a validated psychometric tool measuring depression or quality of life post-intervention. Studies were excluded if: 1) participants had severe impaired cognitive function or severe hearing or visual impairments as defined by validated screening tools, 2) participants had other psychiatric conditions other than depression, 3) participants were recruited from acute hospitals or were institutionalized. Search Strategy: A comprehensive literature review was conducted by searching eight databases (with no date restriction): CINAHL, Embase, ProQuest, PsycINFO, PubMed, Scopus, The Cochrane Library and Web of Science for RCTs and CCTs by combining keywords and index terms. The reference list of the included studies was also searched manually. Data Extraction: Data extracted included: year, author, study design and method, diagnostic tool, characteristics of participants, setting, sample size, intervention, outcomes, outcome measurement and frequency and results. Outcome measures: The primary outcome was depressive symptoms and the secondary outcome was quality of life reported after completion of the intervention. Risk of Bias: Two independent reviewers conducted the risk of bias assessment using the Cochrane Collaboration’s tool for assessing risk of bias. Data Analysis: A meta-analysis was performed, using Review Manager version 5.3 to pool together data. After heterogeneity was assessed, subgroup analysis and sensitivity analysis were conducted. Narrative synthesis was then conducted according to protocol due to high heterogeneity. Results: The systematic search retrieved 1624 records. Five randomised controlled trials were eligible to be included after screening. Meta-analysis revealed a significant effect favouring nurse-led psychotherapy for depressive symptoms (d = -1.72; 95% CI: -2.92 to -0.52; p = 0.005). No significant effect was found for quality of life. There was high heterogeneity among the included studies for both depressive symptoms and quality of life even after subgroup analysis and sensitivity analysis were carried out. Narrative synthesis revealed that three out of five studies reported mean differences in depression symptoms post-intervention that favoured Cognitive-Behavioural Therapy (CBT) and Wheel of Wellness Counselling over the comparator groups. All included studies had either a high risk or an unclear risk judgement for the performance bias domain of the risk of bias assessment. Four out of the five included studies also had an unclear risk judgement for detection bias. Conclusion: The results indicated that there was a significant effect of nurse-led psychotherapy on reducing depressive symptoms of older adults in the community with depression. However, caution is advised when using the results due to a small sample of studies used for meta-analysis and high heterogeneity involved. However, narrative synthesis suggests that it is probable that nurse-led psychotherapy has a positive effect on improving the depressive symptoms of older adults in the community, even though the potential positive effects on quality of life were not observed. Due to its relevance, more research on nurse-led psychotherapy deserves to be carried out in the future to synthesise better quality evidence on its application. Implications: More research regarding each type of nurse-led psychotherapy needs to be carried out in the future to show the effectiveness it has for older adults in the community with depression. Issues with heterogeneity can be addressed with more studies on each type of nurse-led psychotherapy and the use of psychometric tools that are specific to the older adult population.