Self-rated health and the treatment of depression in older adults

More severe physical illness is associated with higher levels of depression. The relationship between physical health and treatment of depression in older adults needs to be investigated in greater detail. This study examines the following hypotheses: (1) Older adults who have poor self-rated health at baseline are less likely to respond to psychotherapy for depression. (2) Older adults whose health ratings improve over the course of treatment are likely to have better treatment outcome for depression. (3) Older adults who are treated with a more structured cognitive or behavioral approach will show a greater decrease in self-ratings of perceived health. This study used archival data from an intervention study conducted in the 1980's. Ninety-one individuals over the age of 60 were randomized to either a cognitive, behavioral or psychodynamic psychotherapy group. They completed assessments at pre-treatment, 6 weeks and post-treatment. The measures included the Beck Depression Inventory (BDI), the Hamilton Rating Scale of Depression (HRSD), the Social Adjustment Scale (SAS) and a Health Questionnaire. The Health Questionnaire consists of three component scales, perceived health, weighted disease and medication use. Weighted disease is a combined score for number of medical illnesses, severity of the illness and patient's discomfort due to the illness. Hierarchical Multiple Regression Analyses were used to examine the effect of pre-treatment ratings of health on treatment outcome as well as for changes in ratings of health on treatment outcome. An ANOVA was performed to assess whether treatment modality was related to change in self-rated health. Objective rating of depression as measured by the HRSD and diagnosis were related to ratings of health at intake. A Subjective measures of depression, the BDI, was related to changes in the perceived health and the weighted disease score. There were no significant group differences for change in perceived health, weighted disease or medication use.