Mindfulness-Based Cognitive Therapy Intervention for the Treatment of Late-Life Depression and Anxiety Symptoms in Primary Care: A Randomized Controlled Trial

(moderate depression/anxiety) on the Patient Health Questionnaire (PHQ-9) and/or General Anxiety Disorder-7 (GAD-7). Participants were randomized 1: 1 into MBCT and treatment as usual (TAU) groups. The MBCT intervention was based on the manualized protocol [7], with some adaptations made to accommodate the needs of older adult participants in the practice. The primary outcome examined changes in depression scores (PHQ-9) between baseline and the 8-week follow-up. The secondary and exploratory outcome included change in anxiety scores (GAD-7) and quality of life (EQ-5D) (further details are in online Supplement 1 and Appendix 1; for all online suppl. material, see www.karger.com/doi/10.1159/000501214). A total of 127 patients were approached for recruitment. Of 76 eligible patients, 61 were enrolled and randomized to intervention (32) or TAU (29) with an 80.3% enrollment rate, a 78% MBCT intervention completion rate (25/32), and a 13% study drop-out rate (8/61) (online suppl. Fig. 1). The mean age of the participants was 67.8 (±6.2) years (between 60 and 85 years) and 72.1% were female. There were no statistically significant differences between MBCT and TAU groups at baseline (online suppl. Table 1). Compared to the TAU group, the MBCT group had a significant reduction in depression symptoms at 8 weeks directly after the treatment (p = 0.002; d = 0.86) (Fig. 1). Additionally, the MBCT group had significant reductions in anxiety (p = 0.001; d = 0.99) and improved quality of life (p = 0.048; d = 0.35) (online suppl. Table 2 and Supplement 2). This is the first RCT of MBCT in older adults with depressive and/or anxiety symptoms in primary care. Our results suggest that MBCT is a feasible intervention with large effect sizes for depression and anxiety symptoms in older adults when compared to TAU. Our findings are extending the literature from younger adults and other uncontrolled studies in older adults, suggesting that MBCT in addition to preventing depression relapse could be efficacious for acute depressive and anxiety symptoms. This may be because older adults tend to have a more routine lifestyle and availability to engage in daily practice. Additionally, MBCT intervention might have various benefits from the group context, including social support, which can help improve loneliness and isolation, which are common in this age and worsen in depression and anxiety [8]. The standard clinical treatment of LLD and LLA often includes antidepressants and psychotherapies. Up to 60% of adults suffering from severe and moderate depression are treatment resistant, and 27% of LLD patients discontinue treatments due to poor tolerability and toxicity [9]. Psychological treatments such as cognitive behavioral therapy have been found to be more efficacious in LLD compared to TAU and waitlisted control (medium effect size d = Dear Editor, Between 10 and 20% of older adults experience symptoms of late-life depression (LLD) and/or late-life anxiety (LLA) annually in primary care, and these numbers are increasing as our population ages [1]. LLD/LLA are often underdetected and undertreated in primary care settings [2]. Moreover, up to 60% of older adults demonstrate an inadequate response to traditional antidepressants due to poor tolerability, adverse effects, drug-drug interactions, and physical/cognitive comorbidity [3]. Although older adults prefer nonpharmacological interventions to psychotropic, services such as one-on-one psychotherapies are often costly and inaccessible due to limited mental health resources [4]. There is an urgent need for scalable nonpharmacological interventions to improve symptoms of LLD and LLA in primary care. Mindfulness-based cognitive therapy (MBCT) is an effective nonpharmacological intervention to prevent depression relapse in younger adults [5]. Few uncontrolled and exploratory studies have suggested that MBCT improved symptoms of LLD/LLA [6]. In this research letter, we report the first randomized controlled trial (RCT) adapted to older adults with symptoms of depression and/or anxiety in primary care. We recruited 61 older adults, aged 60 years and above, suffering from depression and/or anxiety symptoms from five primary care centers in Montreal, QC, Canada, between September 1st, 2016 and December 20th, 2017. Ethics approval had been obtained at the Jewish General Hospital and participants provided written consent. Participants were included if they had a score of ≥10 Received: March 12, 2019 Accepted after revision: May 27, 2019 Published online: July 9, 2019