Original Articles

Life review therapy for older adults with moderate depressive symptomatology: a pragmatic randomized controlled trial

J. Korte^a1 c1, E. T. Bohlmeijer^a1, P. Cappeliez^a2, F. Smit^a3a4 and G. J. Westerhof^a1

^a1 University of Twente, Department of Health, Psychology and Technology, Enschede, The Netherlands

^a2 University of Ottawa, School of Psychology, Ottawa, Ontario, Canada

^a3 Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Centre of Prevention and Early Intervention, Utrecht, The Netherlands

^a4 EMGO+ Institute for Health and Health Care Research, Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

Abstract

Background Although there is substantial evidence for the efficacy of life review therapy as an early treatment of depression in later life, its effectiveness in natural settings has not been studied. The present study evaluates an intervention based on life review and narrative therapy in a large multi-site, pragmatic randomized controlled trial (RCT).

Method Life review therapy was compared with care as usual. The primary outcome was depressive symptoms; secondary outcomes were anxiety symptoms, positive mental health, quality of life, and current major depressive episode (MDE). To identify groups for whom the intervention was particularly effective, moderator analyses were carried out (on sociodemographic variables, personality traits, reminiscence functions, clinically relevant depressive and anxiety symptoms, and past MDEs).

Results Compared with care as usual (n=102), life review therapy (n=100) was effective in reducing depressive symptoms, at post-treatment (d=0.60, B=−5.3, p<0.001), at 3-month follow-up (d=0.50, B=−5.0, p<0.001) and for the intervention also at 9-month follow-up (t=5.7, p<0.001). The likelihood of a clinically significant change in depressive symptoms was significantly higher [odds ratio (OR) 3.77, p<0.001 at post-treatment; OR 3.76, p<0.001 at the 3-month follow-up]. Small significant effects were found for symptoms of anxiety and positive mental health. Moderator analyses showed only two significant moderators, the personality trait of extraversion and the reminiscence function of boredom reduction.

Conclusions This study shows the effectiveness of life review therapy as an early intervention for depression in an ecologically valid context, supporting its applicability to a broad target group. The intervention is also effective in reducing anxiety symptoms and strengthening positive mental health.

(Received March 28 2011)

(Revised July 11 2011)

(Accepted August 30 2011)

(Online publication October 14 2011)

Key Words:

• Depressive symptomatology;
• life-review therapy;
• older adults;
• randomized controlled trial

Correspondence:

^c1 Address for correspondence: J. Korte, M.Sc., University of Twente, Department of Health, Psychology and Technology, Drienerlolaan 5, PO Box 217, 7500 AE Enschede, The Netherlands. (Email: j.korte@utwente.nl)