Non-pharmacological interventions for older adults with depressive symptoms: a network meta-analysis of 35 randomized controlled trials

Abstract

Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms.

Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software.

Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99–3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90–2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84–4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71–3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23–2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects.

Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings.

Keywords:

• depression
• older adults
• non-pharmacological
• intervention
• network meta-analysis

Acknowledgements

We thank all members of our study team for their whole-hearted cooperation and the original authors of the included studies for their wonderful work. We also thank Evidence-Based Medicine Center of Lanzhou University for methodological support.

Authors’ contributions

LG, XXL, KHY and XMH planed and designed the research; LG, XXL and ZTB provided methodological support/advice; YJC and QQL tested the feasibility of the study; YJC, BP, WBW, QQL and GZJ, YFL extract data; YJC and LG performed the statistical analysis; YJC wrote the manuscript; YJC, LG, XXL and KHY revised the manuscript; all authors approved the final version of the manuscript.

Ethics approval and consent to participate

Ethics approval and participants consent are not required because this study is a meta-analysis based on the published studies.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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Additional information

Funding

This work was supported by the China Medical Board [CMB 17–279]; the Fundamental Research Funds for the Central Universities [16LZUJBWTD013, 18LZUJBWZX006, and lzujbky-2018-14]; Gansu Soft Science Project [18CX1ZA043]; and 2015 Gansu Social Science Planning Project [YB004]. The views expressed are those of the authors and not necessarily those of the Lanzhou University. The funders had no role in the study design, data collection, data synthesis, data interpretation or writing of the report.