The Effectiveness of Communitybased psychoeducational programs for prevention of depression in older Adults

Transcription

1 The Effectiveness of Communitybased psychoeducational programs for prevention of depression in older Adults Kusaka, N. 1, Tokutsu, S. 2 1 Doshisha Women s College, Kyoto, 2 Kansai University of Welfare Sciences, Osaka 9th Asia / Oceania Congress of Geriatrics and Gerontology in Melbourne, Australia, from October 23-27, 2011

2 Background The number of suicides in Japan National Police Agency, 2011

3 High risk of depression for older adults in Kyoto Depression and Suicide Screening :DSS (Public health surveys in ) n=3,219 Hifh risk of depression- 10.5% Doshisha Women's College

4 Objective of this study Program development for Japanese older adults for prevention of depression -Comparing with effects of two kinds of programs Physical activity improvement program (ACT) ( Beck, A. T., 1967/ 1970 /1976, Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G., 1979) Peronal goal-setting program (GOAL) ( Dubé, M., Lapierre, S., Bouffard, L., & Alain, M., 2007)

5 Empirical studies on Cognitive Behavior Therapy (CBT) for Older Adults CBT is a beneficial treatment for depressed older adults. (Rokke, Tomhave, & Jocic, 1999; Fry, 1984; Floyd, Scogin, Mckendree-Smith, Gloyd, & Rokke, 2004; Campbell, 1992; Gahhagher-Thompson & Sterffen, 1994) CBT for patients with subthreshold depression have a significant effect on depressive symptomatology. CBT for patients with subthreshold depression may have an effect on the incidence of major depressive disorder. (Cuijpers, P., Smit, F., van Straten, A., 2007, Psychological treatments of subthreshold depresshon: a meta-analytic review, Acta Psychiatr Scand, 115, )

6 Physical activity improvement program (ACT) Improving depressed moods through physical activities Dysfunctional thought concerning with depressive mood Psycoeducation: Gaining the knowledge about prevention of depression

7 Process of the ACT program Stage Strategies covered Tecniques Introduction/ Knowing each participants Psychoeducation Psychoeducation Ⅰ -Introduce mood rating system -Outline relationship between mood and behavior Recreation: Listening to mandolin Psychoeducation/ Behavioral intervention -Learinig about depression Psychoeducation Ⅱ -Identifying connections between mood and activity levels -Establishment of activity scheduling -Identifying obstacles to engaging in pleasant events Psychoeducation/ Cognitive intervention -Learinig about insomnia Psychoeducation Ⅲ -Identifying negative automatic thoughts -Dealing with age-related negative automatic thoughts -Challenging unhelpful and unrealistic thoughts Psychoeducation Ⅳ -Learinig about relationship with family Psychoeducation -Managing worry (thought stopping, using imagery) Thought stopping Psycho-education: Using the services Psychoeducation Ⅴ -Guidance by public health nurse about services -Self management and prevention Ⅵ Out come evaluation -Evaluation of the outcome and progress in the activity Self monitoring Relaxation texhnique Behavioral Experiment Cognitive restructuring

8 Personal Goal-setting Program (GOAL) Improving psychological well-being through life goal pursuit Dysfunctional thought concerning goal pursuit

9 Process of the GOAL program Stage Strategies covered Tecniques Introduction Ⅰ -Knowing each participants -Making personal history sheet -Talk about the turning point of my life Self analysis / Cognitive intervention Ⅱ -Find my strength -Find my automatic thoughts -Find new thoughts Goal setting / Cognitive intervention Ⅲ -Assessment of goal and value -Analysis my goals -Challenging unhelpful and unrealistic thoughts Goal planning Ⅳ -Assertion training Social skill training -Managing worry (thought stopping, using imagery) Thought stopping Goal pursuit Ⅴ -Planning of goal-related action -Execution of the plan, persistence toward the goal -Solving difficulties with the emotional support Ⅵ Out come evaluation -Evaluation of the outcome in reraching the goal Self monitoring Cognitive restructuring Cognitive restructuring Behavioral experiment Graded task assignment Cognitive restructuring

10 Method Structure of Interventions 5 to 7 weekly group sessions Two hours per week 12 to 20 individuals Aged 65 to 82 Conducted by clinical psychologist and social worker Consecutively enrolled at the during the period from 2007 to 2009 for ACT and from 2010 for GOAL

11 Research area: Kyoto

12 Simultaneous Recruitment Act group (n=27; 3 men, 24 women ) (mean age 74.0, 65-80) Goal group (n=14; 5 men, 9 women ) (mean age 69.9, 65-80) Control group (n=34; 7men, 27 women) (mean age 72.3, 65-80) A total of 75 (15 men and 60 women) general population without depressive symptom (SDS: Zung Self-rating Depression Scale < 40), No difference between groups on : age gender, SDS

13 Measures Depressive mood SDS(Zung Self-rating Depression Scale) Psychological Well-being FMQ(Fordyce Emotions Questionnaire) HHS(Herth Hope Scale) PANAS-X(Positive Affects and Negative Affects Scale) Ryff s six psychological well-being scales Knowledge about depression and prevention of depression Depression Prevention Questionnaire (KPDS)

14 Procedure Three time Measurements Pre-test (prior to the session) Post-test( at the last session) Follow-up (3 months later) A two-way repeated -measures ANOVA (group time), followed by the Bonferroni method

15 Results SDS SDS and FMQ FMQ 40 p < 0.001, by rm-anova 12 p < 0.001, by rm-anova 35 * 10 * * * * pr po fo pr po fo pr po fo control act goal 4 pr po fo pr po fo pr po fo control act goal pr : pre, po: post, fo: follow. * significant, vs. pre of the same group. significant, vs. control group of the same time.

16 Knowledge of the Prevention and treatment of Depressive Symptoms (KPDS) No.1 ~ 4 1:Knowledge about depression :Knowledge about prevention * * post follow 3: Knowledge about possibility of prevention * * * post follow post follow 4: Knowledge about importance of medical care post follow :control :act :goal * significant, determined by Mann-Whitney U test.

17 Knowledge of the Prevention and treatment of Depressive Symptoms (KPDS) No.5 ~ 7 5: Knowledge about the support center 6: Doing something for prevention * * post 6: Efficacy in prevention * post follow follow post follow 1. I know how common is depression 2. I know how to prevent depression 3. I know the possibility of prevention 4. I will see the doctor for treatment depression 5. I know about advice center in the city hall 6. I will do something for prevention 7. I can prevent :control :active :goal * significant, determined by Mann-Whitney U test.

18 PANAS positive negative 30 p = 0.771, by rm-anova 22 p = 0.597, by rm-anova pr po fo control pr po fo goal pr po fo control pr po fo goal pr : pre, po: post, fo: follow.

19 Psychological well-being Purpose in life Self-acceptance Positive relations with others p = 0.117, by rm-anova p = 0.167, by rm-anova p = 0.320, by rm-anova pr po fo pr po fo pr po fo pr po fo pr po fo pr po fo control goal control goal control goal pr : pre, po: post, fo: follow.

20 Summary and Discussion The effectiveness of these two programs based on CBT was demonstrated. Behavioral techniques of CBT helped alter the participants perception and behavior. Psychoeducation in ACT directly affects participants knowledge and efficacy of prevention of depression. FOR further program improvement Psychoeducational program based on CBT is needed. Structural improvement is needed such as the numbers of sessions. ALSO More adequate measurement to assess the outcome of the program Development of the inclusive prevention program

21 Acknowledgement This study was conducted through, Grant-in-Aid for Scientific Research (C) and Grant-in-Aid for Exploratory Research for the Japanese Government. http//www2.dwc.doshisha.ac.jp/ikiiki Doshisha Women's College