Symposium
Aging and Lifespan Psychology
Viviana Wuthrich, Ph.D., Other (she/her/hers)
Professor
Macquarie University
Macquarie University, New South Wales, Australia
Henry Cutler, Ph.D.
Professor
Macquarie University
Macquarie University, New South Wales, Australia
Denise meuldijk, PhD (she/her/hers)
Postdoctoral Research Fellow
University of New South Wales
Kensington, New South Wales, Australia
Tina Huang-Smith, Other
Student
Macquarie University
Macquarie University, New South Wales, Australia
Katrina Swavley, BPsych(Hons) (she/her/hers)
Masters Student
Macquarie University
Macquarie Park, New South Wales, Australia
Lauren F. McLellan, D. Phil.
Senior Lecturer
Macquarie University
Macquarie University, New South Wales, Australia
Pim Cuijpers, PhD
Professor
Vrije Universiteit Amsterdam
Amsterdam, Noord-Holland, Netherlands
Michael Jones, Ph.D.
Professor
Macquarie University
Macquarie University, New South Wales, Australia
Ronald Rapee, Ph.D.
Distinguished Professor
Macquarie University
Sydney, New South Wales, Australia
.jpg "Carly Johnco, Ph.D. (she/her/hers) photo")
Carly Johnco, Ph.D. (she/her/hers)
Associate Professor
Macquarie University
Sydney, New South Wales, Australia
Jessamine Chen, Ph.D., Other
Professor
Macquarie University
Macquarie University, New South Wales, Australia
Henry Brodaty, M.D., Ph.D.
Professor
University of New South Wales
Sydney, New South Wales, Australia
Brian Draper, M.D., Ph.D.
Professor
University of New South Wales
Sydney, New South Wales, Australia
There are no rigorous evaluations of clinical effectiveness, cost savings, feasibility or acceptability of stepped care approaches to CBT in older adult mental health services. Stepped care relies on provision of low intensity (lower cost) services first, followed by higher intensity (higher cost) services only if needed. The use of stepped care can potentially reduce service costs and increase access to CBT especially for those living in rural and remote areas. This pre-registered two-armed parallel-group multi-site, pragmatic, superiority clinical trial compared CBT delivered via two therapy steps to usual care in five public and private health services in Australia.
122 older adults ( >65 years) with clinically interfering symptoms of depression and/or anxiety were randomised to stepped care or usual care at each site. Step 1 was 10 weeks of online CBT or bibliotherapy CBT supported by brief therapist calls, followed by up to 10 weeks of individual therapist-led CBT in step 2 only if therapeutically required. Usual care in public sites comprised case-management and medication review, and in private site best-practice individual CBT. Participants completed demographic, self-report symptom measures, semi-structured clinical interviews conducted by reviewers blind to treatment allocation, quality of life and economic measures, pre-treatment, 13- and 26-weeks post baseline and at 12-month post baseline. Acceptability of CBT delivered by stepped care was evaluated.
Adhering to intent-to-treat, linear mixed-effects models demonstrated non-significant group by time interactions on the primary outcome collapsed across sites. However, statistically significant site effects indicated stepped care was superior to usual care in public services, but not statistically different in private services. Acceptability was mixed.
Applying CBT using stepped care was associated with significantly greater reductions in anxiety and depression in older adults compared to usual care in public services, but not statistically significant outcomes in the private site. Step 1 led to large effect size benefits comparable to best-practice CBT.