Intimacy in Depressed Elderly with Axis II Comorbidity

Duke University, Durham NC

Investigators

Abstract

Major depression is a serious and prevalent psychiatric disorder among the elderly. Psychotropic and psychosocial interventions have been used with some success, still significant numbers of patients fail to respond adequately to treatment. Approximately one third of depressed elderly patients show only partial response to treatment, and partial responses are associated with higher rates of relapse. Many others are unable to tolerate pharmacotherapy because of existing medical conditions, interactions with other prescription medications, and unwanted side effects. Thus, it is important to understand the factors associated with treatment resistant depression in the elderly. Many patients with chronic depression have co-existing personality disorders (PD's) that complicate treatment. Comorbid PD's among the elderly have been associated with poorer response to treatment, greater risk of suicide, and impaired social support. Social support factors have been associated with the onset and maintenance of depressive symptoms and level of emotional support, in particular, appears to have a critical role in the course of depressive disorders. However, research investigating intimate relationships in the elderly have been scarce, overly global, and often contradictory. The primary aim of the proposed study is to better understand tile role of emotional support and relationship quality in the treatment of older adults with major depression and coexisting Axis II psychopathology. This study is an add-on to a larger project investigating the relative outcomes of antidepressant medication and a combination of cognitive-behavioral therapy plus antidepressant medication for this complex population. Thirty-six subjects (n = 36) will complete pre- and post-treatment assessments, including questionnaires, interviews, and interaction tasks. Videotaped interactions will be coded using the IDGOS, an observational coding system that measures intimacy. Bivariate correlations and MANCOVA procedures will be used to examine correlations between relationship factors and depressive symptoms at Time 1 and Time 2. Data from this study will clarify the role between emotional support and complex depression in the elderly and will yield estimates of effect size for a subsequent K Award submission. Thus, the proposed study is the first step in a research trajectory aimed at developing and testing a couple/family intervention for improving outcomes among treatment resistant elderly.