Perceived needs for mental health care and barriers to treatment across age groups.

PURPOSE: This study aimed to assess responses to a structured measure of perceived need for treatment to understand whether differences in treatment uptake across age groups are related to differences in: (1) perceived need for mental health care; (2) perceptions of treatment needs being met; and/or (3) perceived attitudinal and structural treatment barriers. METHODS: Data from a nationally representative sample of the Australian population (2007 National Survey of Mental Health and Wellbeing) were analysed using logistic and multinomial regression. All participants potentially benefiting from mental health services were included in analyses; including those reporting symptoms of mental disorders, using mental health services, or self-reporting significant mental health problems in the past 12 months (n = 5733). All regression analyses were adjusted for gender, the presence of chronic physical health conditions, disorder type, and disorder severity. RESULTS: Older adults were the least likely to report any perceived need for mental health care, and specifically reported lower needs for psychotherapy, information about available services, and support improving their ability to work. Older adults perceiving a need for mental health care were also the most likely to report having these needs met. There were no differences in attitudinal and structural barriers to treatment across age groups. CONCLUSIONS: These results highlight that age needs to be considered in strategies for improving engagement and efficacy of mental health services, as well as the need for further research to understand what drives age differences in perceived need for mental health care.

Randomized controlled trial of group cognitive behavioral therapy compared to a discussion group for co-morbid anxiety and depression in older adults.

BACKGROUND: Co-morbid anxiety and depression in older adults is associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments in older adults. However, there is a paucity of research focused on testing the efficacy of the co-morbid treatment of anxiety and depression in older adults using psychological interventions. Accordingly, the primary objective of the current study was to test the effects of a group cognitive behavior therapy (CBT) program in treating co-morbid anxiety and depression in a sample of older age adults. METHOD: A total of 133 community-dwelling participants aged ⩾60 years (mean age = 67.35, s.d. = 5.44, male = 59) with both an anxiety disorder and unipolar mood disorder, as assessed on the Anxiety Disorder Interview Schedule (ADIS), were randomly allocated to an 11-week CBT group or discussion group. Participants with Mini-Mental State Examination scores <26 were excluded. Participants were assessed pre-treatment, post-treatment and at 6 months follow-up on the ADIS, a brief measure of well-being, Geriatric Anxiety Inventory and Geriatric Depression Scale. RESULTS: Both conditions resulted in significant improvements over time on all diagnostic, symptom and wellbeing measures. Significant group × time interaction effects emerged at post-treatment only for diagnostic severity of the primary disorder, mean severity of all anxiety disorders, mood disorders, and all disorders, and recovery rates on primary disorder. CONCLUSION: Group CBT produced faster and sustained improvements in anxiety and depression on diagnostic severity and recovery rates compared to an active control in older adults.

The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study.

There is some evidence that cognitive flexibility negatively impacts cognitive restructuring skill acquisition with brief training; however, there is little understanding of how this relates to learning cognitive restructuring over the course of a therapy program, and how it relates to overall treatment outcome. This study assessed the impact of cognitive flexibility on cognitive restructuring skill acquisition following group CBT, and on treatment outcome, along with changes in cognitive flexibility over treatment. 44 older participants with anxiety and depression completed self-report and neuropsychological tests of cognitive flexibility and a clinical interview at pre and post-treatment. Qualitative and quantitative measures of cognitive restructuring were completed at post-treatment. Pre-treatment cognitive flexibility was not related to the quality of cognitive restructuring at post-treatment or overall treatment outcome. However, it did predict reduction in subjective units of distress from using cognitive restructuring and therapist ratings of cognitive restructuring ability at post-treatment. Few participants showed changes in cognitive flexibility over treatment. Those with poorer cognitive flexibility may not find cognitive restructuring as useful to alleviate emotional distress as those with better cognitive flexibility. However, those with poorer cognitive flexibility can still benefit from standardised CBT, even if their use of cognitive restructuring is less effective.

The role of cognitive flexibility in cognitive restructuring skill acquisition among older adults.

Cognitive flexibility is one aspect of executive functioning that encompasses the ability to produce diverse ideas, consider response alternatives, and modify behaviors to manage changing circumstances. These processes are likely to be important for implementing cognitive restructuring. The present study investigated the impact of cognitive flexibility on older adults' ability to learn cognitive restructuring. Neuropsychological measures of cognitive flexibility were administered to 40 normal community-dwelling older adult volunteers and their ability to implement cognitive restructuring was coded and analyzed. Results indicated that the majority of participants showed good cognitive restructuring skill acquisition with brief training. The multiple regression analysis suggested that those with poorer cognitive flexibility on neuropsychological testing demonstrated poorer quality cognitive restructuring. In particular, perseverative thinking styles appear to negatively impact the ability to learn cognitive restructuring. Further research is needed to clarify whether older adults with poor cognitive flexibility can improve their cognitive restructuring skills with repetition over treatment or whether alternative skills should be considered.

The Cool Teens CD-ROM for anxiety disorders in adolescents : a pilot case series.

Five adolescents received a multimedia CD-ROM containing a self-help treatment program for young people with an anxiety disorder. Participants used the 8-module Cool Teens CD-ROM over a 12-week period on a home computer. Every 2 weeks, they received a brief telephone call from a clinical psychologist to monitor symptoms and progress and to discuss any problems with understanding content or implementing techniques. Based on structured interviews, two participants (40%) no longer met diagnostic criteria (self-report ADIS) for at least one clinical anxiety disorder immediately following treatment and these same participants no longer met diagnostic criteria for any clinical anxiety disorder at 3-month follow-up. Two other participants failed to make gains based on diagnostic criteria, but showed improvement in anxiety symptoms for one main fear. Participants were generally satisfied with the multimedia content, the modules, and the delivery format of the program.