Journal Club
| BACKGROUND | |
| Background | Major Depressive Disorder (M.D.D.) is a common problem with elderly patients. Several forms of therapy have been employed in the treatment. For instance, pharmacotherapy, psychotherapy, cognitive-behavioural therapy, interpersonal and problem-solving therapy. Art therapy, on the other hand, has been used on many patients and has improved the psychological framework of depression in elderly patients under pharmacological treatment. |
| Previous Trials | Psychotherapy has been used widely in the treatment of depression; it has been effective with the elderly population. Cognitive-behavioural therapy, problem-solving, and interpersonal therapy are the first treatments applied to elderly patients. |
| GENERAL STUDY OVERVIEW | |
| Title/Citation | Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial. |
| Funding | Funding information was not provided, |
| Null Hypothesis | The therapists did not know the component that resulted in the observed effects. The therapists did not know whether the treatment would be as successful in male participants as it was in female participants. |
| Trial Design | The participants read and signed an informed consent, which was approved by the local ethics committee. The study was also approved by the FMUSP ethics committee. It was registered with the Brazilian Registry of Clinical Trials and the World Health Organization International Clinical Trials Registry Platform. 94 patients were contacted and considered for the trial, but 66 of them were approved. At the end of the study, 56 participants were present- 25 in the control group and 31 in the experimental group. The 31 experimental group participants were awarded 20 art therapy workshops but the control group participants did not receive psychotherapy. However, they could get involved in the workshops after the study. |
| Objective | To prove that art therapy contributes to the improvement of psychological therapy. To assess the effects of 20 sessions of art therapy in women suffering from major depressive disorder while receiving pharmacological treatment. |
| METHODS | |
| Inclusion Criteria | The study was conducted on elderly females above the age of 60. They had to agree to participate in the study and have the ability to read and write. The patients had to maintain their pharmacological treatment based on the fact that their symptoms were improving with the dose while displaying the least side effects. |
| Exclusion Criteria | The study excluded dementia patients, drug users, degenerative diseases, and cancer patients with renal impairment and poor prognosis. |
| Interventions | The patients were subjected to the same tests carried out by neuropsychologists in the beginning and the end of the 20-week study. Each test took 45 minutes. The experimental group participants were tested after 20 art therapy sessions, while the control group participants were not taken through any interventions. The therapy sessions lasted 90 minutes, led by an art specialist. The intervention involved 3 groups of 11 participants each; the participants worked on their artistic output individually. The sessions were divided into welcome, relaxation and guided imagery, artistic output, and verbal expressions. |
| Follow-up/Monitoring | The participants were given sociodemographic questionnaires about their medical history, depressive episodes, and presence of other diseases, other than depression. |
| Primary Endpoints | Interpersonal Therapy, which relates to social interaction between the patients. Depression Management Therapy that handles depression-related issues. Life Review Therapy that considers revisiting past situations. |
| Secondary Endpoint | The tests restricted the recruitment to female elderly patients. |
| Statistical Analyses | The Kolmogorov-Smirnov method was used to test normal distribution of data. The Mann-Whitney U test compared sociodemographic data, depressive episodes, and psychiatric variables between the experimental and control groups. The chi-square test and the Fisher’s exact test tested the connection between categorical changes and group administrations. The Wilcoxon test compared the scores between the two groups. |
| RESULTS | |
| Enrolment | 94 patients were enrolled. 28 did not meet the criteria for different reasons. The 66 participants were reduced to 56 because 8 individuals were contacted but they did not show up. 1 of them was incompatible and 1 did not adopt the applied technique. |
| Baseline Characteristics | Averagely, the participants were female patients, above the age of 60, can read and write, and agreed to take part in the study. |
| Primary Outcomes | Improvement in anxiety and depression symptoms in the patients. Reduction in depression in patients in the experimental group. |
| Secondary Outcomes | Fear of solitude, death, disease, and measure of existence were addressed through actions. |
| Other Outcomes | Most of the participants related positively with each other and the therapists before, during, and after the sessions. Art therapy may not only assist major depressive disorders but also cancer patients. |
| AUTHORS CONCLUSIONS | |
| They authors thought that art therapy was successful in improving anxiety and depression symptoms in major depression disorder patients. Art therapy may be used as a catalyst to pharmacotherapy in treating depression. | |
| DISCUSSION | |
| Patient Population | The participants were in the same gender group, which was the purpose of the study. Hence the results were accurate. The use of separate interviews contributed to the overall results, meaning the participants were not influenced in their choices. |
| Intervention | The study was approved by the Ethics department hence its compliance was assessed. The sessions were conducted for 90 minutes, led by an art specialist. |
| Endpoints | The tests were clinically significant and are a clear representation of the study. The study had objectives that were straight to the point and the hypothesis matched them. |
| Statistics | The tests employed in collecting data were appropriate because the results were accurate. The fact that the results were restricted to female elderly patients was an error in the overall research. |
| PRESENTER’S CONCLUSION | |
| The objectives of the study were met. The results were restricted to female elderly patients. The investigators should conduct the research and sessions to male patients to ascertain the viability of art therapy in improving depressive and anxiety symptoms. | |
| STRENGTHS | WEAKNESSES |
| Study Design Inclusion/exclusion criteria Statistics | Population size Quality of endpoints |
Work Cited
Ciasca, Eliana C., et al. “Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial.” Brazilian Journal of Psychiatry 40.3 (2018): 256-263.