Aging Women and Depression custom essay

[meteor_slideshow slideshow=”fe1″]

The course Research Article Review Paper assignment requires a review and critical examination of a single, peer-reviewed, evidence-based, published article covering scientifically conducted psychology-related research, which is the foundation of the discipline and practice of psychology.

This paper must be based on a single published article that reports on a study conducted by the author(s). Essay style, expert opinion and multi-study review articles are not permitted for this assignment. The article you review must be drawn from the APUS Online Library. The Library has tutorials and librarians available if you need assistance navigating it and conducting article searches, something you will need to use in future courses.

This assignment will be completed via a step-wise process of first identifying your article and attaching a pdf copy of it along with your paper topic proposal to the paper assignment tab by the end of Week 3 of the course. This step is NOT optional. If it is not completed with an instructions-compliant article selection by the Week 3 deadline, 50 points will be deducted from the 200 points possible for the full review paper due Week 6 with no options for submitting the topic proposal or the article pdf copy after the Week 3 deadline to avoid the point loss.

The required length of the review paper body (not counting title and Reference pages) is 5-6 pages. The paper must be properly source credited with APA formatted source citations both in the paper body and in a ?Reference? page attached to the end. Correct source crediting means the words of the article author or authors are paraphrased (restated in the student?s own words, not copied), with a paper body source credit immediately following any paraphrasing and each source credited also listed in an attached Reference page. Quoting is not needed for this assignment (your instructor will be assessing the meaning you made of the material and the degree to which you analyzed and synthesized it with course readings and concepts, not how well you can quote words written by someone else). Only a brief sentence or two of quoting is permitted and they must be in quotation marks with a source credit immediately following. Papers not following the above rules are, by definition, plagiarized and will be assigned zero points per the course rule concerning academic integrity.

The paper body will begin with an introduction identifying the article?s primary focus and end with 2 conclusion pages describing how the research methods used might have impacted the research results, ideas for future research inspired by the article and the impact the article?s research results might have on the real world.

The full review paper will:

? Identify the article, the author(s) and the date of publication, both in the body of the paper and in an attached Reference list, and the focus of the research

? Describe the hypothesis of the study

? Describe how the study was conducted including
The population that was studied
The methodology used (i.e. naturalistic observation, experiment, case study, survey, etc).
How the data was collected and analyzed

? Describe the results of the study

? Discuss concepts, theories, and principles included in the course textbook to show synthesis of what has been learned in the course related to the information in the article reviewed.

? End with a 2-page conclusion which
Reviews the way the research was conducted and potential impact on results (e.g. problems with the study methodology that might have affected its validity and/or generalizability).
Describes three future research ideas inspired by the article
Describes the potential impact the research findings might have in the ?real world? lives of everyday people.

The course Research Article Review Paper assignment requires a review and critical examination of a single, peer-reviewed, evidence-based, published article covering scientifically conducted psychology-related research, which is the foundation of the discipline and practice of psychology.

This paper must be based on a single published article that reports on a study conducted by the author(s). Essay style, expert opinion and multi-study review articles are not permitted for this assignment. The article you review must be drawn from the APUS Online Library. The Library has tutorials and librarians available if you need assistance navigating it and conducting article searches, something you will need to use in future courses.

This assignment will be completed via a step-wise process of first identifying your article and attaching a pdf copy of it along with your paper topic proposal to the paper assignment tab by the end of Week 3 of the course. This step is NOT optional. If it is not completed with an instructions-compliant article selection by the Week 3 deadline, 50 points will be deducted from the 200 points possible for the full review paper due Week 6 with no options for submitting the topic proposal or the article pdf copy after the Week 3 deadline to avoid the point loss.

The required length of the review paper body (not counting title and Reference pages) is 5-6 pages. The paper must be properly source credited with APA formatted source citations both in the paper body and in a ?Reference? page attached to the end. Correct source crediting means the words of the article author or authors are paraphrased (restated in the student?s own words, not copied), with a paper body source credit immediately following any paraphrasing and each source credited also listed in an attached Reference page. Quoting is not needed for this assignment (your instructor will be assessing the meaning you made of the material and the degree to which you analyzed and synthesized it with course readings and concepts, not how well you can quote words written by someone else). Only a brief sentence or two of quoting is permitted and they must be in quotation marks with a source credit immediately following. Papers not following the above rules are, by definition, plagiarized and will be assigned zero points per the course rule concerning academic integrity.

The paper body will begin with an introduction identifying the article?s primary focus and end with 2 conclusion pages describing how the research methods used might have impacted the research results, ideas for future research inspired by the article and the impact the article?s research results might have on the real world.

The full review paper will:

? Identify the article, the author(s) and the date of publication, both in the body of the paper and in an attached Reference list, and the focus of the research

? Describe the hypothesis of the study

? Describe how the study was conducted including
The population that was studied
The methodology used (i.e. naturalistic observation, experiment, case study, survey, etc).
How the data was collected and analyzed

? Describe the results of the study

? Discuss concepts, theories, and principles included in the course textbook to show synthesis of what has been learned in the course related to the information in the article reviewed.

? End with a 2-page conclusion which
Reviews the way the research was conducted and potential impact on results (e.g. problems with the study methodology that might have affected its validity and/or generalizability).
Describes three future research ideas inspired by the article
Describes the potential impact the research findings might have in the ?real world? lives of everyday people.

Article is below:

Aging Women and Depression
Margaret Gatz and Amy Fiske
University of Southern California
Practicing psychologists will increasingly have the opportunity to include older women with depression
among their clients. Research on depression in older women is summarized, including rates of disorder,
age of onset, symptom profiles, suicidal behavior, risk factors for depression such as physical health and
social inequalities, and protective factors such as spirituality. The empirical literature about treatment of
depression in older adults is presented, with special attention to psychotherapeutic approaches. Ways in
which information can help mold effective service provision are enumerated.
Older women will increasingly be seen in the offices of clinical
practitioners. The purpose of this article is to focus on one of the
main complaints of older women: depression. At the outset, it is
imperative to be clear that being an older woman does not, in and
of itself, put one at elevated risk for depressive disorder. However,
there are groups of older women who are at special risk for
depression, and there are groups of older women to whom special
treatment considerations pertain. This information will help practitioners
to provide the best care.
There are two reasons that more older women will be seen by
clinicians in the coming years. One is the explosion in the number
of older adults. Longevity has increased, and the age structure is
changing such that older adults will account for an increasingly
large proportion of the U.S. population. Particularly among the
oldest old, women will greatly outnumber men. Thus, sheer numbers
of people with any age-related disease will increase purely as
a function of the population context (Jeste et al., 1999). Second,
women who are joining the ranks of older adults are increasingly
from generations that are more psychologically minded and more
likely to see psychotherapy as an option (Belcher, Haley, Becker,
& Polivka, 1999).
It is important to appreciate the distinction between age and
cohort (or generation). Women now aged 80 and older were born
in 1920 and before. Women who will enter their 80s in 2020 were
born in the 1940s. What is true of 80-year-olds today may not be
true of 80-year-olds in 2020. For this reason, we sometimes use the
phrase ?women now old? to avoid making unwarranted inferences
about what will be true for women who will join the elderly in the
future.
One critical way in which future cohorts of older women will
differ is in the distribution of ethnicity and culture. Whereas 85%
of Americans aged 65 and older in 1995 were non-Hispanic White,
this proportion is expected to decline to 66% by 2030 (Siegel,
1999). Whereas the cohort of women now old includes large
numbers who migrated from Europe, future aged will include
individuals who came to the United States from Latin America and
Asia following changes in immigration law in the 1950s and 1960s
or as political refugees.
Rates of Depression in Women Now Old
Epidemiological data lead to three conclusions: Rates of major
depressive disorder are lower in older women than in younger
women (see Jeste et al., 1999). Rates of depressive symptoms are
lower in midlife and become elevated among the oldest old
(Krause, 1999). Gender differences commonly observed in depression
and depressive symptoms at younger ages become lessened in
older adults (Barefoot, Mortensen, Helms, Avlund, & Schroll,
2001; Rokke & Klenow, 1998).
The most recent, large-scale epidemiological study to include
older adults is the Epidemiologic Catchment Area Study (ECA;
Weissman, Bruce, Leaf, Florio, & Holzer, 1991). Although the
findings have not been contradicted by any later investigations,
there is a need for more updated studies that include older women.
In the ECA sample, the 1-year prevalence of major depressive
disorder in women 65 and older was 1.5%, and 2.3% of women 65
and older met criteria for dysthymia. Clinically significant depressive
symptoms are more common than disorders. In community
surveys, 15?25% of older adults exceed the cutoff on various
self-report depression checklists (see Jeste et al., 1999). Higher
rates of depression are found among medical inpatients and outpatients,
and high rates of depression are also found among residents
in long-term care, with estimates of major depression for
men and women combined ranging from 6% to 25% (Blazer &
Koenig, 1996).
Although depression at most ages is more prevalent in women
than in men, many studies find this difference to diminish with age
(Barefoot et al., 2001; Veijola et al., 1998). The convergence of
rates appears to be a result of decreasing rates of depression with
MARGARET GATZ completed her PhD in clinical psychology at Duke
University. She is a professor in the Department of Psychology at the
University of Southern California (USC) and foreign adjunct professor in
the Department of Medical Epidemiology at the Karolinska Institute in
Stockholm, Sweden. Her research concerns the mental health of older
adults.
AMY FISKE received her PhD in clinical psychology from USC. She is
currently a research assistant professor in the Department of Psychology at
USC. She conducts research on late life depression as well as on the
etiology of dementia.
THIS ARTICLE WAS DEVELOPED for the Summit on Women and Depression,
October 2000, Queenstown, MD.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Margaret
Gatz, Department of Psychology, University of Southern California,
Seeley G. Mudd Building, Room 520, 3620 McClintock Avenue, Los
Angeles, California 90089-1061. E-mail: gatz@usc.edu
Professional Psychology: Research and Practice Copyright 2003 by the American Psychological Association, Inc.
2003, Vol. 34, No. 1, 3?9 0735-7028/03/$12.00 DOI: 10.1037/0735-7028.34.1.3
3
age among women, whereas rates among men either remain stable
or increase. Some studies examining depressive symptoms, rather
than disorders, have also found a convergence in mean scores with
age (Rokke & Klenow, 1998).
A number of conceptual and methodological challenges having
to do with validity of measurement of depression syndromes,
sampling bias, and cohort effects may lead to either underestimation
or overestimation of rates of depression (see Karel, 1997;
Krause, 1999). Some of these challenges are listed below.
1. Older adults may express disorder through different symptoms
not well represented in criteria from the Diagnostic and
Statistical Manual of Mental Disorders (American Psychiatric
Association, 1994). Therefore, rates of depressive disorder may be
underestimates of ?true? depression among older adults. This topic
is addressed in the Symptom Profiles section.
2. When depression is comorbid with physical health problems,
symptoms of depression may be overlooked or attributed to medical
causes. Because older adults often have physical health problems,
cases of depression may be missed and rates would therefore
represent underestimates.
3. Conversely, most checklists of depressive symptoms include
items measuring the somatic indicators of depression, such as sleep
disturbance or feeling tired. Older adults who endorse these symptoms
may not be depressed but rather may have physical illnesses
or conditions. Thus, self-report depression scales may lead to
inflated scores or overestimation, also accounting for the apparent
discrepancy between rates of diagnosed disorder and proportions
exceeding a clinical cutoff score. This issue is also tackled in the
Symptom Profiles section.
4. Older adults may forget earlier incidents of depression when
given a structured lifetime interview. Therefore, lifetime rates of
depression in older adults would be underestimates.
5. Older adults in long-term care institutions are not sufficiently
represented in epidemiological samples, and there is a high rate of
depression in nursing homes (Weissman et al., 1991). Therefore,
published rates of depression may represent underestimates. In
addition, older women are more likely than older men to live in
long-term care facilities. Thus, the convergence of rates of depression
for men and women may represent an artifact of not including
women who live in nursing homes in the samples under study.
6. Older adults who have a history of major depression may be
less likely to survive into old age, leading to the incorrect conclusion
that rates of depression decrease with age.
7. Others have argued that the low rate of depressive disorder in
those now old represents a true cohort effect, with cohorts born
after World War II having higher rates of depression (Weissman et
al., 1991). If true, there will be a rise in rates of depression in older
adults of the future because more people will be bringing disorders
with them to old age.
Age of Onset
Among older adults with depression, approximately half represent
cases of late-onset depression (Weissman et al., 1991). Some
studies have found a tendency for women more often to be in the
early-onset group and men to have late-onset depression
(Lavretsky, Lesser, Wohl, & Miller, 1998).
A subset of late-onset depression has been associated with
structural brain changes, vascular risk factors, and cognitive impairment.
Alexopoulos and colleagues (1997) referred to these
cases as vascular depression. The symptom profile associated with
vascular depression includes psychomotor retardation and apathy,
absence of dysphoria, extrapyramidal signs, and poor performance
on neuropsychological tests of frontal functioning (Alexopoulos et
al., 1997). Such cases may be resistant to antidepressant treatment
or electroconvulsive therapy and may have a more chronic course
than other depression. At least a portion of these cases may
progress to vascular dementia (Hickie, Scott, Wilhelm, & Brodaty,
1997).
Another subset of late-onset depression may be prodromal to
Alzheimer?s disease. For example, Nussbaum, Kaszniak, Allender,
and Rapcsak (1995) found that 22% of adults aged 70 or older who
were diagnosed with depression without cognitive impairment
went on to demonstrate progressive dementia consistent with Alzheimer?s
disease within 2 years.
Symptom Profiles
Numerous studies have found differences in the symptom profiles
that characterize depression in late life compared with earlier
in the life span. In diagnostic interviews, older adults?both
women and men?are less likely than younger individuals with the
same overall level of depression to endorse dysphoria (Gallo,
Rabins, & Anthony, 1999), a feature that can lead to underdetection
of major depression in epidemiological surveys. Several investigators
(e.g., Newmann, Engel, & Jensen, 1991) have distinguished
a constellation of symptoms that are more frequent in
older adults, and in older women specifically, called depletion
syndrome. This group of symptoms includes loss of interest, loss
of energy, hopelessness, helplessness, and psychomotor retardation.
This cluster differs from a typical depressive syndrome (Newmann
et al., 1991). The depletion cluster should not be confused
with somatic symptoms, although there is some overlap?for example,
with respect to fatigue. The somatic symptoms are more
likely to be endorsed because of medical conditions and not
depression, whereas the depletion symptoms may reflect physiological
overlap?for example, vascular depression. Along these
lines, Karel (1997) suggested that differences in presentation of
depressive symptoms with age may reflect differences in risk
factors. For example, physical illness, dementia, and loneliness
may relate to apathy and depletion symptoms, whereas prior history
of depression and interpersonal problems may relate to mood
symptoms.
Suicide
Suicidal behavior among older women has received little research
attention, perhaps because extraordinarily high rates of
suicide among older men overshadow the problem in older
women. Although women commit suicide less frequently than men
do at all ages, this difference is most pronounced in late life
(McIntosh, Santos, Hubbard, & Overholser, 1994). Canetto (1995)
argued, however, that study of older women may yield important
clues to protective factors against suicide, such as a flexible coping
style or societal proscription against suicide by women.
Although depression is implicated in suicidal deaths at all ages,
it may be particularly important to the understanding of suicide
among older women. Depression has been found more frequently
4 GATZ AND FISKE
among older women as opposed to older men who attempted or
committed suicide (Quan & Arboleda-Flo?rez, 1999), whereas
older men were more likely to have had financial or physical
health difficulties.
A large proportion of older adults who commit suicide visit a
primary care physician within a short interval before death, but
evidence indicates they do not receive more intensive treatment
commensurate with the higher levels of psychopathology than
nonsuicidal primary care patients (Conwell et al., 2000). One
reason may be that physicians tend to normalize depression and
suicidal ideation in older adults (Uncapher & Arean, 2000).
Although older women engage in overt acts of suicide less
frequently than do older men, they may be at greater risk of
indirect suicidal behavior. Osgood, Brant, and Lipman (1991)
examined indirect suicides in 463 nursing homes in the United
States and found that over 80% of suicidal behavior was indirect,
most commonly a conscious, persistent refusal to eat, drink, or take
medications. Staff frequently noted depressive symptoms in the
records of these residents. The rate of death attributable to indirect
suicidal behavior among women, 60/100,000, was 10 times greater
than the suicide rate for community-dwelling older women. Little
research in any age group has tested whether treatment for depression
can reduce suicidal behavior, including indirect suicidal
behavior.
Correlates of Depression
Genetic Risk
Most investigators have concluded that genetic risk factors play
some role in major depression. In addition, early-onset depression
reflects greater genetic influence than later onset (Maier et al.,
1991). For depressive symptoms, twin studies have found that in
older adults depletion symptoms show higher heritability than
mood symptoms (Gatz, Pedersen, Plomin, Nesselroade, & Mc-
Clearn, 1992).
Health
Physical health status is the most consistently reported risk
factor for the onset and persistence of depression in late life (see
Blazer & Koenig, 1996). Few studies have analyzed the effects of
health on depression by gender, and of those that have, most found
few differences (Beekman, Kriegsman, Deeg, & van Tilburg,
1995). Health factors may influence depression in several ways:
Illness, impairment in functioning, and pain may act as discrete
stressors or sources of chronic strain; some illnesses may have a
direct physiological effect that results in depressive symptoms
(e.g., stroke or Parkinson?s disease); depression may be a side
effect of some medications; and depression may increase reporting
of health-related symptoms. The effect of health status on depression
in aging women is particularly important from a public health
standpoint, because older women are more likely than either
younger women or older men to have functional limitations. The
relationship between health status and depression may also be
reciprocal, with depression precipitating or exacerbating disability
or pain, or contributing to mortality, perhaps through the impact of
depression on the performance of self-care activities or by compromising
immune functioning.
Subsyndromal or minor depression, that is, presence of depressive
symptoms that do not reach the threshold for diagnosis of a
depressive disorder, is particularly common in medical settings,
where it may be overlooked for treatment because it is interpreted
as a normal reaction to hospitalization. Among medical inpatients,
however, those with minor depression have symptom patterns and
depressive symptom histories that more closely resemble those
with major depression than nondepressed patients (Mossey, 1997).
Depression may be a feature of the physical, cognitive, and
emotional changes that occur toward the end of life. Individuals
who are terminally ill may show a type of depression that resembles
exhaustion (Macleod, 1998). For these individuals, there may
be overlap between fatigue, depletion, and vascular depression.
Social Inequalities
Women who experience disadvantage early in life may be at
greater risk of depression later in life. Early life stresses that have
been related to depression in late life include loss of a parent,
poverty, and disrupted education (Krause, 1999). These risk factors
predict both worse physical and worse psychological health.
Krause theorized that early disadvantage may have an accelerating
impact over the life course through mechanisms such as stress
proneness, interference with social ties, and long-term consequences
of low educational attainment. No attention has been paid
to gender differences; however, it is possible to think of forms of
disadvantage (e.g., abruptly terminated education, low income) to
which women might be disproportionately subjected.
Stressful Events
The notion that depression may result from the accumulation of
stressful events in one?s life has intuitive appeal. However, unlike
in younger samples, aggregate measures of recent life events show
little relationship with depression in late life (Beekman et al.,
1995). Several stressful conditions occurring in late life have been
associated with depression. These include illness and disability,
bereavement, being forced to relocate, and caregiving. Contrary to
conventional wisdom, retirement is not a risk factor for depression
among older adults (Kivela?, Ko?nga?s-Saviaro, Laippala, Pahkala, &
Kesti, 1996).
Death of one?s spouse tends to be associated with a variety of
grief reactions, including elevated depressive symptoms. With
respect to age differences in the impact of widowhood, loss of
one?s spouse becomes more common as an individual and her
spouse become older. There is some indication that middle-aged
widows express higher depressive symptoms than older widows.
However, the relationship between symptoms and age may be
curvilinear, with greater effects in both younger widows and in the
oldest old, whose own physical health and social networks may be
more compromised (Turvey, Carney, Arndt, Wallace, & Herzog,
1999).
There are fewer data on gender differences, in part because
widowers tend more often to remarry. In the aging literature, there
is very little information about loss of a partner other than a
spouse, including same-sex couples. The balance of extant literature
tends toward finding widowers to be at greater risk than
widows with respect to a variety of indicators of distress (van
Grootheest, Beekman, van Groenou, & Deeg, 1999). For widows,
SPECIAL SECTION: AGING WOMEN AND DEPRESSION 5
depressive symptoms were partially explained by concerns about
income. For widowers, the most important mediator of depressive
symptoms was loss of emotional support.
Caregiving for a family member with physical illness or dementia
represents a risk factor for depression that has particular significance
for older women. Caregiving responsibilities, which are
associated with elevated levels of depression (Lutzky & Knight,
1994), are more likely to fall to women than to men. Furthermore,
among caregivers, women are at higher risk for depression than are
men (Lutzky & Knight, 1994). African American caregivers are
less likely to experience depression than Caucasian caregivers,
possibly due to culture-specific mechanisms for managing stress
(Haley et al., 1996), whereas Latina caregivers appear to experience
levels of distress similar to those that Anglo caregivers
experience (Aranda & Knight, 1997).
Social Context
Social support that is appraised as positive has been associated
with lower depressive symptoms and may buffer the effects of ill
health, disability, bereavement, or other stressors (e.g., Wallsten,
Tweed, Blazer, & George, 1999). Structural variables, such as size
and composition of the social network, are less strongly related to
depressive symptoms than are more subjective dimensions. Paradoxically,
social support, when too intensive, has also been associated
with increased depressive symptoms, possibly by eroding
the individual?s sense of personal control and self-efficacy (Wallsten
et al., 1999). Reciprocity may also be relevant, as Wallsten
and colleagues found that level of support given to others was
associated with lower levels of depressive symptoms, consistent
with predictions of exchange theory.
No gender differences in the relationship between social context
and depression in late life have been reported; however, despite
obvious gender role differences in how social ties are navigated,
most research has simply not examined gender differences.
Spirituality
Spirituality has been conceptualized as a coping strategy that
may buffer the effects of stressful life events on depression. Over
one third of medically ill older adults spontaneously mentioned
religion in response to an open-ended inquiry into their coping
strategies (Koenig, 1998), and two thirds said they used religion to
a large extent in this capacity. Caregivers frequently mention
religion as a coping mechanism. Religion may be particularly
important among older women, as they report higher levels of
religiosity than do older men (Husaini, Blasi, & Miller, 1999;
Koenig, 1998).
Different dimensions of religiosity?public religiosity, private
religious behaviors, and religious coping?may differ in their
effects on depression. Public religious behavior has generally not
been associated with depression in older adults (Husaini et al.,
1999). Private religiosity (e.g., prayer or Bible study) has been
shown in most studies to buffer the effects of stressful events and
disability on depression among older women and men (Husaini et
al., 1999). Consistent gender differences have not been found.
Religious coping is defined as solving problems or reducing distress
through the use of religious behaviors that are categorized as
positive (e.g., seeking support from God) or negative (e.g., spiritual
discontent).
Treatment of Depression in Older Women
It is well documented that treatments for depression are effective
for older adults (for a casebook and resource guide, see Karel,
Ogland-Hand, & Gatz, 2002). The most usual treatment is antidepressant
medication. Psychotherapy has also been studied, with
cognitive, behavioral, brief psychodynamic, and interpersonal
therapies all having some empirical support. A third approach to
treatment of severe depression, ECT, tends to be used disproportionately
with older adults compared with other age groups.
Effectiveness seems comparable for drugs and psychotherapy.
For example, Niederehe and Schneider (1998) summarized the
literature as showing 60% improvement for those on medication
versus 13% for those on placebo, with a dropout rate of 25% to
30%, whereas Gerson, Belin, Kaufman, Mintz, and Jarvik (1999)
found that symptom severity was reduced 51% for those on drug
versus 21% for those on placebo. For psychotherapy, Gerson et al.
found that symptom severity was also reduced 51%, with an
average dropout rate of 29%. The Niederehe and Schneider overview
reported a 70% response rate for psychotherapy. Treatment
guidelines indicate that psychotherapy has utility for mild to moderate
but not severe depression, but there is little research evidence
to support or refute this conclusion. The standard of care is
combined psychosocial and pharmacological treatment (e.g., Niederehe
& Schneider, 1998), although little research has tested this
conclusion.
Most studies include more older women than older men in their
samples and either do not mention gender differences in outcome
or find that there is no difference. A summary of the literature by
Tuma (2000) concluded that there was a worse prognosis for
elderly men than for elderly women across outcome studies not
selected for type of treatment, and a worse prognosis for those with
more medical problems. Treatment considerations that must be
taken into account more often with older adults include comorbid
medical illness and cognitive impairment. At the same time, clinical
trials in older adults often exclude those with physical health
limitations and the oldest old.
The work of two research groups warrants note. Gallagher-
Thompson, Thompson, and colleagues have conducted a large
number of studies comparing cognitive, behavioral, and brief
psychodynamic treatments for major depressive disorder, and
more recently have compared cognitive behavioral therapy to
antidepressant medication and combined treatment. Thompson,
Gallagher, and Breckenridge (1987) used 20 sessions of individual
cognitive, behavioral, and brief dynamic therapy. At posttest, all
therapies led to significant improvement relative to a waiting-list
control group on self-report and observer-rated scales and on
proportions of patients diagnosed as depressed. Thompson, Coon,
Gallagher-Thompson, Sommer, and Koin (2001) compared a
16?20 session cognitive?behavioral therapy (CBT) protocol,
pharmacotherapy with a tricyclic antidepressant, or combined CBT
and drug treatment. Both CBT alone and the combined treatment
were superior to drug alone, and there was no difference between
CBT alone and the combined treatment, although there was some
hint that the combined treatment might be better than CBT alone
for severe depression. Dropout was higher for women than for men
6 GATZ AND FISKE
and overall was 26% for CBT, 34% for drug alone, and 42% for
combined (Gradman, Thompson, & Gallagher-Thompson, 1999).
Reynolds and colleagues have focused on avoiding relapse or
recurrence. Acute treatment involves combined antidepressant
medication and interpersonal therapy (IPT) followed by continuation
therapy, entailing 16 weeks of combined treatment. Thereafter,
patients are randomized to one of four maintenance therapy
conditions: drug, placebo, IPT plus placebo, or IPT plus drug. All
treatments were superior to placebo. Recurrence rates of major
depression were 90% for placebo, 64% for IPT plus placebo, 43%
for drug alone, and 20% for IPT plus drug (Reynolds, Frank, Perel,
et al., 1999). In patients aged 60 and older, there were no age
differences in response to acute or continuation therapy. However,
relapse was more common among those whose first onset of
depression was in old age and for those aged 75 and older, who
also had more comorbid medical conditions (Reynolds, Frank,
Dew, et al., 1999). For this oldest group, combined treatment did
seem to offer an advantage.
Policy Considerations
Access to mental health care is an important policy issue. Risk
factors for depression suggest groups who might benefit from
targeted outreach. Currently, older women and older men with
depression are most often seen by their primary care physicians.
Less than optimal medication strategies may be used by primary
care physicians, such as offering fewer of the newer antidepressant
medications and giving benzodiazapines (i.e., anxiolytics; Bartels,
Horn, Sharkey, & Levine, 1997). Psychotherapy has not typically
been offered as an alternative treatment. Large demonstration
studies sponsored by the National Institute of Mental Health, the
Substance Abuse and Mental Health Services Administration, and
the Hartford Foundation are now in progress to improve detection
of depression by primary care physicians and to connect patients in
primary care to optimal treatment for depression, including psychopharmacologic
and psychotherapeutic interventions.
Financing of mental health care services for older adults continues
to be a barrier to older consumers (Koenig, George, &
Schneider, 1994). This concern may be particularly salient for
older women, who may suffer financial strain due to earlier social
inequities or loss of spouse. Another presumed barrier to access to
treatment for depression is that older adults would not want to be
seen as mentally ill. However, older adults have been found to be
less concerned about stigma than the stereotype might suggest
(e.g., Belcher et al., 1999). On the basis of short descriptions of
alternative treatments, older adults preferred behavioral (activity)
therapy to psychodynamic, cognitive, and drug therapies, in that
order, with the difference between behavioral therapy and pharmacotherapy
statistically significant (Rokke & Scogin, 1995). It is
also possible to package cognitive and behavioral treatments as
?bibliotherapy? or as courses.
Implications for Clinicians
The reviewed evidence indicates that (a) numbers of older
women with depressive disorders will continue to increase, not
because older women are unusually depressed, but because they
form a significant segment of the population, and (b) older women
who suffer from depressive disorders can benefit from psychotherapy
but are often unlikely to be offered this treatment alternative.
Clinicians who wish to serve this segment of the population should
consider the following.
1. The generation in which a woman grew up will affect her
views and values. Clinicians must inquire about and respect these
cohort differences just as they respect other cultural differences.
Future cohorts of older women will reflect different patterns of
immigration in comparison to women now old. In particular, there
will be increased proportions of older women with cultural ties to
the Pacific Rim. Psychologists will need to simultaneously take
into account culture-specific differences in the presentation of
depression, culture-specific preferences for treatment, and knowledge
about adult development and aging.
2. Depression is not an inevitable concomitant of aging. When
an older woman is depressed, it should not be normalized but
should be recognized and treated.
3. An older woman who is experiencing depression for the first
time in her life undoubtedly has a reservoir of personal strengths
nurtured through a lifetime of coping. Clinicians can draw on these
strengths in helping the woman deal with the current situation.
4. Depression may be harder to recognize in older adults, both
by clinicians and by older adults themselves, because active dysphoria
is less predominant than more subtle symptoms such as
reduced motivation or fatigue.
5. Depression is often a correlate or side effect of physiological
changes, physical illness, or medication. This fact makes treatment
both harder and easier?harder because it may not be possible to
eliminate the physical disorder, but easier because there is an
objective source for the depression that the clinician and client can
address together.
6. Older women with functional limitations, in severe pain, or
providing caregiving for a demented spouse may be among those
at special risk for depression. Psychoeducational efforts by clinicians
can help to prevent or reduce depression among these at-risk
groups and to bring those with problems into treatment.
7. Just because depression may have a physical basis does not
mean that behavioral and cognitive interventions are inappropriate.
It does mean that psychologists need to work in partnership with
primary care physicians to ensure that physical diseases are being
treated and that medications are being monitored (or even changed
to other drugs with fewer depressive side effects).
8. Although relatively few older women actively commit suicide,
the number involved in indirect self-destructive behaviors
may be significantly higher. Because the relationship between
depression and suicide may be stronger for older women than for
other demographic groups, it is particularly important for clinicians
to treat depression in this group and remain alert to signs of
hopelessness. Because most older adults who commit suicide are
seen in primary care shortly before the death and depression may
be inadequately treated in this setting, psychologists could play a
valuable role in training medical staff and providing psychological
treatment in coordination with medical care.
9. Controlled clinical trials support the efficacy of cognitive,
behavioral, and interpersonal psychotherapies for depression in
older adults. Older adults find psychotherapy to be an acceptable
treatment. Providing a rationale for the treatment, couched in
accessible psychoeducational terms, aids in forming a commitment
to treatment.
SPECIAL SECTION: AGING WOMEN AND DEPRESSION 7
10. Continued lobbying for mental health care coverage is
required, as finances will otherwise pose a significant barrier
to access to mental health care for older women, especially
for psychotherapeutic alternatives to psychopharmacological
treatments.
Despite older adults? need for mental health services, there are
not enough trained professionals and insufficient training opportunities
for graduate students in professional psychology (Jeste et
al., 1999). We hope that this review will encourage clinicians to
seek continuing education that will further their knowledge of
psychological interventions with older adults and to regard older
women as a challenging and rewarding practice opportunity.
References
Alexopoulos, G. S., Meyers, B. S., Young, R. C., Campbell, S., Silbersweig,
D., & Charlson, M. (1997). ?Vascular depression? hypothesis.
Archives of General Psychiatry, 54, 915?922.
American Psychiatric Association. (1994). Diagnostic and statistical manual
of mental disorders (4th ed.). Washington, DC: Author.
Aranda, M. P., & Knight, B. G. (1997). The influence of ethnicity and
culture on the caregiver stress and coping process: A sociocultural
review and analysis. Gerontologist, 37, 342?354.
Barefoot, J. C., Mortensen, E. L., Helms, M. J., Avlund, K., & Schroll, M.
(2001). A longitudinal study of gender differences in depressive symptoms
from age 50 to 80. Psychology and Aging, 16, 342?345.
Bartels, S. J., Horn, S., Sharkey, P., & Levine, K. (1997). Treatment of
depression in older primary care patients in health maintenance organizations.
International Journal of Psychiatry in Medicine, 27, 215?231.
Beekman, A. T. F., Kriegsman, D. M. W., Deeg, D. J. H., & van Tilburg,
W. (1995). The association of physical health and depressive symptoms
in the older population: Age and sex differences. Social Psychiatry and
Psychiatric Epidemiology, 30, 32?38.
Belcher, C. R., Haley, W. E., Becker, M. A., & Polivka, L. A. (1999).
Attitudes about mental health services among older adults [Abstract].
Gerontologist, 39, 534.
Blazer, D. G., & Koenig, H. G. (1996). Mood disorders. In E. W. Busse &
D. G. Blazer (Eds.), Textbook of geriatric psychiatry (pp. 235?263).
Washington, DC: American Psychiatric Press.
Canetto, S. S. (1995). Elderly women and suicidal behavior. In S. S.
Canetto & D. Lester (Eds.), Women and suicidal behavior (pp. 215?
233). New York: Springer.
Conwell, Y., Lyness, J. M., Duberstein, P., Cox, C., Seidlitz, L., DeGiorgio,
A., & Caine, E. D. (2000). Completed suicide among older patients
in primary care practices: A controlled study. Journal of the American
Geriatrics Society, 48, 23?29.
Gallo, J. J., Rabins, P. V., & Anthony, J. C. (1999). Sadness in older
persons: 13-year follow-up of a community sample in Baltimore, Maryland.
Psychological Medicine, 29, 341?350.
Gatz, M., Pedersen, N. L., Plomin, R., Nesselroade, J. R., & McClearn,
G. E. (1992). The importance of shared genes and shared environments
for symptoms of depression in older adults. Journal of Abnormal Psychology,
101, 701?708.
Gerson, S., Belin, T. R., Kaufman, A., Mintz, J., & Jarvik, L. (1999).
Pharmacological and psychological treatments for depressed older patients:
A meta-analysis and overview of recent findings. Harvard Review
of Psychiatry, 7, 1?28.
Gradman, T. J., Thompson, L. W., & Gallagher-Thompson, D. (1999).
Personality disorders and treatment outcome. In E. Rosowsky, R. C.
Abrams, & R. A. Zweig (Eds.), Personality disorders in older adults:
Emerging issues in diagnosis and treatment (pp. 69?94). Mahwah, NJ:
Erlbaum.
Haley, W. E., Roth, D. L., Coleton, M. I., Ford, G. R., West, C. A., Collins,
R. P., et al. (1996). Appraisal, coping, and social support as mediators of
well-being in black and white family caregivers of patients with Alzheimer?s
disease. Journal of Consulting and Clinical Psychology, 64,
121?129.
Hickie, I., Scott, E., Wilhelm, K., & Brodaty, H. (1997). Subcortical
hyperintensities on magnetic resonance imaging in patients with severe
depression: Longitudinal evaluation. Biological Psychiatry, 42, 367?
374.
Husaini, B. A., Blasi, A. J., & Miller, O. (1999). Does public and private
religiosity have a moderating effect on depression? A bi-racial study of
elders in the American South. International Journal of Aging and
Human Development, 48, 63?72.
Jeste, D. V., Alexopoulos, G. S., Bartels, S. J., Cummings, J. L., Gallo,
J. J., Gottlieb, G. L., et al. (1999). Consensus statement on the upcoming
crisis in geriatric mental health. Archives of General Psychiatry, 56,
848?853.
Karel, M. J. (1997). Aging and depression: Vulnerability and stress across
adulthood. Clinical Psychology Review, 17, 847?879.
Karel, M. J., Ogland-Hand, S., & Gatz, M. (2002). Assessing and treating
late-life depression. New York: Basic Books.
Kivela?, S.-L., Ko?nga?s-Saviaro, P., Laippala, P., Pahkala, K., & Kesti, E.
(1996). Social and psychosocial factors predicting depression in old age:
A longitudinal study. International Psychogeriatrics, 8, 635?644.
Koenig, H. G. (1998). Religious attitudes and practices of hospitalized
medically ill older adults. International Journal of Geriatric Psychiatry,
13, 213?224.
Koenig, H. G., George, L. K., & Schneider, R. (1994). Mental health care
for older adults in the Year 2020: A dangerous and avoided topic.
Gerontologist, 34, 674?679.
Krause, N. (1999). Mental disorder in late life: Exploring the influences of
stress and socioeconomic status. In C. S. Aneshensel & J. C. Phelan
(Eds.), Handbook of the sociology of mental health (pp. 183?208). New
York: Kluwer Academic/Plenum.
Lavretsky, H., Lesser, I. M., Wohl, M., & Miller, B. (1998). Relationship
of age, age at onset, and sex to depression in older adults. American
Journal of Geriatric Psychiatry, 6, 248?256.
Lutzky, S. M., & Knight, B. G. (1994). Explaining gender differences in
caregiver distress: The roles of emotional attentiveness and coping
styles. Psychology and Aging, 9, 513?519.
Macleod, A. D. (1998). Methylphenidate in terminal depression. Journal of
Pain and Symptom Management, 16, 193?198.
Maier, W., Lichtermann, D., Minges, J., Heun, R., Hallmayer, J., &
Klingler, T. (1991). Unipolar depression in the aged: Determinants of
familial aggregation. Journal of Affective Disorders, 23, 53?61.
McIntosh, J. L., Santos, J. F., Hubbard, R. W., & Overholser, J. C. (1994).
Elder suicide: Research, theory and treatment. Washington, DC: American
Psychological Association.
Mossey, J. M. (1997). Subdysthymic depression and the medically ill
elderly. In R. L. Rubinstein & M. P. Lawton (Eds.), Depression in long
term and residential care (pp. 55?74). New York: Springer.
Newmann, J. P., Engel, R. J., & Jensen, J. E. (1991). Age differences in
depressive symptom experiences. Journal of Gerontology, 46, P224?
P235.
Niederehe, G., & Schneider, L. S. (1998). Treatments for depression and
anxiety in the aged. In P. E. Nathan & J. M. Gorman (Eds.), A guide to
treatments that work (pp. 270?287). New York: Oxford University
Press.
Nussbaum, P. D., Kaszniak, A. W., Allender, J., & Rapcsak, S. (1995).
Cognitive decline in elderly depressed: A follow-up study. The Clinical
Neuropsychologist, 9, 101?111.
Osgood, N. J., Brant, B. A., & Lipman, A. (1991). Suicide among the
elderly in long-term care facilities. New York: Greenwood Press.
Quan, H., & Arboleda-Flo?rez, J. (1999). Elderly suicide in Alberta: Difference
by gender. Canadian Journal of Psychiatry, 44, 762?768.
8 GATZ AND FISKE
Reynolds, C. F., III, Frank, E., Dew, M. A., Houck, P. R., Miller, M.,
Mazumdar, S., et al. (1999). Treatment of 70 year olds with recurrent
major depression: Excellent short-term but brittle long-term response.
American Journal of Geriatric Psychiatry, 7, 64?69.
Reynolds, C. F., III, Frank, E., Perel, J. M., Imber, S. D., Cornes, C.,
Miller, M. D., et al. (1999). Nortriptyline and interpersonal therapy as
maintenance therapies for recurrent major depression: A randomized
trial in patients older than 59 years. Journal of the American Medical
Association, 28, 39?45.
Rokke, P. D., & Klenow, D. J. (1998). Prevalence of depressive symptoms
among rural elderly: Examining the need for mental health services.
Psychotherapy, 35, 545?558.
Rokke, P. D., & Scogin, F. (1995). Depression treatment preferences in
younger and older adults. Journal of Clinical Geropsychology, 1, 243?
257.
Siegel, J. S. (1999). Demographic introduction to racial/Hispanic elderly
populations. In T. P. Miles, E. Wang, C. P. Mouton, J. N. Henderson, A.
Mui, M. P. Aranda, et al. (Eds.), Full-color aging: Facts, goals, and
recommendations for America?s diverse elders (pp. 1?19). Washington,
DC: Gerontological Society of America.
Thompson, L. W., Coon, D. W., Gallagher-Thompson, D., Sommer, B.R.,
& Koin, D. (2001). Comparison of desipramine and cognitive/behavioral
therapy in the treatment of elderly outpatients with mild-to-moderate
depression. American Journal of Geriatric Psychiatry, 9, 240?255.
Thompson, L. W., Gallagher, D., & Breckenridge, J. S. (1987). Comparative
effectiveness of psychotherapies for depressed elders. Journal of
Consulting and Clinical Psychology, 55, 385?390.
Tuma, T. A. (2000). Outcome of hospital-treated depression at 4.5 years:
An elderly and a younger cohort compared. British Journal of Psychiatry,
176, 224?228.
Turvey, C. L., Carney, C., Arndt, S., Wallace, R. B., & Herzog, R. (1999).
Conjugal loss and syndromal depression in a sample of elders aged 70
years or older. American Journal of Psychiatry, 156, 1596?1601.
Uncapher, H., & Arean, P. A. (2000). Physicians are less willing to treat
suicidal ideation in older patients. Journal of the American Geriatrics
Society, 48, 188?192.
van Grootheest, D. S., Beekman, A. T. F., van Groenou, M. I. B., & Deeg,
D. J. H. (1999). Sex differences in depression after widowhood. Do men
suffer more? Social Psychiatry and Psychiatric Epidemiology, 34, 391?
398.
Veijola, J., Puukka, P., Lehtinen, V., Moring, J., Lindholm, T., & Vaisanen,
E. (1998). Sex differences in the association between childhood
experiences and adult depression. Psychological Medicine, 28, 21?27.
Wallsten, S. M., Tweed, D. L., Blazer, D. G., & George, L. K. (1999).
Disability and depressive symptoms in the elderly: The effects of instrumental
support and its subjective appraisal. International Journal of
Aging and Human Development, 48, 145?159.
Weissman, M. M., Bruce, M. L., Leaf, P. J., Florio, L. P., & Holzer, C., III.
(1991). Affective disorders. In L. N. Robins & D. A. Regier (Eds.),
Psychiatric disorders in America (pp. 53?80). New York: Free Press.
Received June 26, 2002
Revision received October 7, 2002
Accepted October 9, 2002 

[meteor_slideshow slideshow=”fe2″]

Focusessays.com has been offering academic support services to students since 2002 and more than 60% of our customers are return clients. We have skilled and experienced writers in all academic levels and subjects. Entrust us with your assignment and you will get a custom essay which is 100% original within its deadline. Get value for your money, confidentiality is guaranteed and customer support services/communication with your writer are available 24/7. Place your Order Now.

Focus Essays has been there for more than 10 years to offer students like you academic writing services.

Get our experience by placing an order with us and use the discount code PAPER15 to get 15% discount on all orders.

We deliver URGENT ORDERS within 6 hours. Get a quotation from the calculator below.

TRY OUR SERVICES TODAY.

[order_calculator]