Studies of older adults' preferences for psychotherapy

A community based survey of older adults' preferences for treatment of anxiety.

By Mohlman, Jan

Psychology and Aging, Vol 27(4), Dec 2012, 1182-1190.

Abstract

Despite the prevalence of anxiety in later life, there are no published studies on treatment preferences of older adults for anxiety problems. The current study utilized a survey method to inquire about treatment preferences in three age group cohorts (N = 383; young-, middle-, and oldest-old) recruited from the community, as opposed to primary care. Participants were asked to imagine that they were suffering from anxiety that had become severe enough to interfere with daily activities and were seeking mental health treatment. Each was asked to first indicate their preference for pharmacological, psychological, or combined treatment. Those who chose psychological or combined treatment were then asked to indicate which specific psychotherapeutic intervention they preferred from a list of six possible choices and to indicate their preference for setting and format of treatment. The sample generally preferred psychotherapy to medicationor combined treatment for help with anxiety, delivered either in a primary care, specialty mental health, or university setting. Furthermore, specific treatment and format preferences varied by age group. Some of the current results (e.g., preference for psychotherapy over medication) run counter to those obtained from studies of depression treatment preference in samples of similar age (e.g., preference for medication over psychotherapy; Gum et al., 2006). (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Abstract

OBJECTIVES: To examine rates and predictors of lifetime and recent depression treatment in a sample of 1,801 depressed older primary care patients

DESIGN: Cross sectional survey data collected from 1999 to 2001 as part of a treatment effectiveness trial.

SETTING: Eighteen primary care clinics belonging to eight organizations in five states.

PARTICIPANTS: One thousand eight hundred one clinic users aged 60 and older who met diagnostic criteria for major depression or dysthymia.

MEASUREMENTS: Lifetime depression treatment was defined as ever having received a prescription medication, counseling, or psychotherapy for depression. Potentially effective recent depression treatment was defined as 2 or more months of antidepressant medications or four or more sessions of counseling or psychotherapy for depression in the past 3 months.

RESULTS: The mean age ± standard deviation was 71.2 ± 7.5; 65% of subjects were women. Twenty-three percent of the sample came from ethnic minority groups (12% were African American, 8% were Latino, and 3% belonged to other ethnic minorities). The median household income was $23,000. Most study participants (83%) reported depressive symptoms for 2 or more years, and most (71%) reported two or more prior depressive episodes. About 65% reported any lifetime depression treatment, and 46% reported some depression treatment in the past 3 months, although only 29% reported potentially effective recent depression treatment. Most of the treatment provided consisted of antidepressant medications, with newer antidepressants such as selective serotonin reuptake inhibitors constituting the majority (78%) of antidepressants used. Most participants indicated a preference for counseling or psychotherapy over antidepressant medications, but only 8% had received such treatment in the past 3 months, and only 1% reported four or more sessions of counseling. Men, African Americans, Latinos, those without two or more prior episodes of depression, and those who preferred counseling to antidepressant medications reported significantly lower rates of depression care.

CONCLUSION: The findings suggest that there is considerable opportunity to improve care for older adults with depression. Particular efforts should be focused on improving access to depression care for older men, African Americans, Latinos, and patients who prefer treatments other than antidepressants.