Measurements of Functioning as Possible Predictors of Encountering Barriers during a Novel Psychotherapy for Older Adults with Major Depressive Disorder

Abstract

Purpose: To examine baseline measurements of functioning as possible predictors of encountering barriers in the novel psychotherapy, Engage. Background: Depression has been shown to have a profound effect on three domains of functioning—global, psychological, and executive—that can be measured upon patient intake. Major depressive disorder in older adults, also known as late life depression (LLD), is widely underdiagnosed and undertreated. Even when patients are able to access treatment, they may still encounter barriers during therapy that can affect its effectiveness. The ability to predict the presence of cognitive and emotional barriers during treatment has the potential to provide clinicians with information that could personalize treatment for those suffering with LLD, resulting in better health outcomes. Methods: This study was a secondary analysis of a sample of 35 older adults with major depressive disorder enrolled in Engage, a 9-week course of streamlined psychotherapy for LLD. We focused on three domains of functioning (global, psychological, and executive), which were measured at baseline via the World Health Organization Disability Assessment Schedule (WHODAS), the Hamilton Depression Rating Scale (HDRS), and Stroop Color-Word task, respectively. We then used logistic regression models to conduct a preliminary investigation of whether these measurements of baseline functioning predicted encountering barriers during participation in Engage. Additionally, we also conducted a post hoc exploratory analysis of two other potential predictors of encountering barriers, the Behavioral Activation for Depression Scale (BADS) and the General Efficacy Scale (GES). Univariate regression models that met a minimum p value ≤ 0.15 would be included in a multivariate model. Results: Only one measurement of functioning (BADS, p = .13) met criteria for multivariate model inclusion, but failed to show significant evidence of a predictive relationship on its own. The WHODAS (β = 0.06, p=0.18), HDRS (β = 0.05, p=0.55), and Stroop (β = -0.04, p= 0.21), failed to predict barriers in this analysis. Conclusion: We were unable to detect an association between baseline measurements of functioning and encountering barriers during psychotherapy. However, given the utility of such a predictive measure in addressing barriers to treatment, further study with a larger sample size is needed. The ability to use a patient’s baseline measurements of functioning to predict encountering cognitive and emotional barriers during psychotherapy could ultimately lead to better treatment outcomes via more timely recognition and intervention of barriers during psychotherapeutic treatment.