Efficacy and effectiveness of psychological interventions on co‐occurring mood and anxiety disorders in older adults: A systematic review and meta‐analysis

• Published in: International journal of geriatric psychiatry Vol. 36; no. 6; pp. 858 - 872
• Main Authors: Wuthrich, Viviana M., Meuldijk, Denise, Jagiello, Tess, Robles, Alberto González, Jones, Michael P., Cuijpers, Pim
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-06-2021
• Subjects: Anxiety; Anxiety disorders; Clinical significance; Clinical trials; Cognitive ability; comorbidity; depression; Emotional disorders; geriatric; Geriatric psychiatry; Mental depression; Meta-analysis; Mood; Mood disorders; Older people; psychological therapy; Remission; Systematic review; anxiety; comorbidity; psychological therapy; meta-analysis; depression; geriatric; systematic review
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.5486

Objectives
Co‐occurring mood and anxiety disorders are common in older adult populations and are associated with worse long‐term outcomes and poorer treatment response than either disorder alone. This systematic review and meta‐analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co‐occurring mood and anxiety disorders in older adults.
Method
The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines.
Inclusion
Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post‐treatment. ResultsFour studies were included (total n = 255, mean age range 67–71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co‐occurring anxiety (Hedges' g = −0.44), and treating anxiety in the presence of depression (Hedges' g = −0.55). However, conclusions are limited; the meta‐analysis was non‐significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow‐up were not established.
Conclusion
Co‐occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high‐quality clinical trials are needed that target the treatment of co‐occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.
Key Points
Comorbid anxiety and mood disorders are common in older adults and are associated with worse outcomes than anxiety or mood disorders alone
Few psychological interventions have examined the efficacy of treating co‐occurring mood and anxiety disorders in older adults, and the quality of these studies is mixed
Limited evidence suggests that psychological therapy can simultaneously target anxiety and mood disorders with moderate effect sizes
Significantly more research is needed to understand the efficacy of psychological interventions to target comorbid mood and anxiety disorders in older adults