Predicting development and treatment of common mental disorders in older adults
Anxiety and Depression in Older People PhD Scholarship 2019: School of Psychology, University of Sussex
Supervisor: Dr Darya Gaysina, Dr Clara Strauss, Dr Nick Grey
One in five older adults is affected with depression and/or anxiety and needs professional help. Improving Access to Psychological Therapies (IAPT) services are open to all adults, however very fewer older adults access it, and only half of those who receive treatment get better. Because our population is getting older, we urgently need to know who are at a higher risk of depression and anxiety in late adulthood, and how to develop effective treatments for everyone. This PhD project will identify predictors of depression and anxiety, and outcomes of psychological treatments, in older adults. To achieve this, two complementary approaches will be used. First, the project will develop a new prediction model for depression and anxiety using data from the oldest British birth cohort that follows >5000 men and women born in Britain in 1946 through their entire life (up to age 69). Second, the project will test whether tools to identify the risk of depression and anxiety could be used to predict who will benefit most from psychological treatments offered by the IAPT service. Findings of the project will have important implications for developing more effective preventions and treatments against depression and anxiety in late life.
Research Student Student: Alexandra Schmidt
Hello, I’m Ali and I’m due to start my PhD at the University of Sussex in September 2019.
Following a successful professional career in Finance, I completed an Access to Higher Education Diploma in Psychology from City College Brighton & Hove. During this time, I also volunteered at a day centre for people living with a personality disorder.
I have recently completed my undergraduate degree at the University of Sussex, where I graduated with a first class honours. For my dissertation, I investigated the effects of lifetime physical activity on cognitive function and mental health in midlife.
I have gained research experience as a Junior Research Assistant programme at the University of Sussex during which I looked at the association between physical activity and depressive symptoms for individuals having had adverse childhood experiences. I presented my findings in poster exhibitions and a national conference. I further volunteered as a Research Assistant supporting a study looking at the association between sleep and cognitive function in older adults.
Depression and anxiety are highly prevalent in older people and are often viewed as normal part of growing old. Volunteering as a befriender for elderly people I have experienced the effects of social isolation, which is one of the contributors to depression in older life and I am therefore eager to start my research into the predictors for development and treatment of depression and anxiety in older people.
I look forward to working with Dr Darya Gaysina, Dr Nick Grey and Dr Clara Strauss and am very grateful to Mental Health Research UK for this fantastic opportunity.
Scientific Goal: The scientific goal of the proposed PhD project is to identify factors that contribute to an increased risk of common mental disorders, such as depression and anxiety, in older adults. Specifically, key research objectives are: 1) to identify the state of the art and gaps in the existing research on predictors of common mental disorders, as well as on access, use, and outcomes of psychological treatments, in older adults; 2) to develop a new prediction model using information on multiple risk and protective factors for the development of common mental disorders in a general population; 3) to investigate whether tools to identify the risk of common mental disorders could be integrated into health care services to predict engaging with and benefitting from current psychological treatments offered by the Improving Access to Psychological Therapies (IAPT) services.
Progress Report Year 2, 2021
Background to my PhD research
Worldwide, the human population is ageing and life expectancy is increasing. However, healthy life expectancy does not keep track with this development, and time spent in poor health has increased. Depression and anxiety are common amongst older adults and are linked with other health conditions and higher mortality. This places a burden on the older person, their carer and society as a whole. This is exacerbated by the current pandemic that has seen the proportion of older adults being affected by common mental health problems increase and has left many older adults facing difficult situations, where they are afraid to go outside yet struggle to cope with the loneliness and isolation of lockdown.
Psychological treatments, such as cognitive-behavioural therapy, have been found to be effective in treating CMHP in older adults, however, only for around half of the treated adults. The identification of predictors treatment outcomes of psychological therapy for CMHP for older adults could have important clinical implications, such as the tailoring of treatments to individuals or the development of new interventions for people that do not respond to current approaches.
My PhD has three main aims:
To conduct a systematic literature review and meta-analysis on predictors of psychological treatment outcomes for older adults.
To investigate predictors for engagement in and outcome of psychological treatment for Improving Access to Psychological Therapies (IAPT) service users
To explore risk factors and their combination and develop prediction models for CMHP, taking a life-course approach in a nationally representative cohort
With regards to research aim 1, the main activities this year was to review and collate research findings for my systematic literature review looking into the predictors of psychological treatment outcomes for depression and anxiety disorders in older adults. I have pre-registered the review protocol PROSPERO and after review of over 2,000 articles left 34 articles for inclusion in the review. The findings show that various factors may impact treatment outcomes across different areas: psychosocial (e.g. coping style), clinical (e.g. baseline symptom severity), treatment related (e.g. homework compliance), neurobiological (e.g. cognitive flexibility) and socio-demographic (e.g. education). However, overall, the process has highlighted that research in this area is relatively sparse, very varied and requires replication, which I aim to do in my next study.
Earlier this year, I was accepted to present the findings of the review at a national conference, the MQ Mental Health Summit (see poster attached). I am now in the process of writing up the findings of my systematic review, which I aim to submit for publication in the next month.
Looking at research aim 2, the major activity was to prepare the NHS ethics application documentation for my study running in the Improving Access to Psychological Therapies (IAPT) in the NHS. Informed by the findings of my systematic review, the aim is to see if any of the factors identified in the review could predict who does or does not benefit from psychological treatment in the IAPT services. To this end, I have created a baseline questionnaire of potential treatment outcome predictors which study participants will be asked to complete prior to commencing treatment. Applying for NHS ethics approval is lengthy and complex process and requires the preparation of various different documents, for example the development of a detailed research protocol. However, this preparation has certainly helped me to think through how my study will work and has allowed me to gain vital research experience, for example, engagement with the lived experienced advisory panel, who have provided invaluable feedback into the study design and documentation. Following the NHS ethics approval, my plan is to begin recruitment and data collection in autumn this year which will continue until end of 2022.
Work on research aim 3 will commence this autumn. I plan to apply for ethical approval for the study as well as access to the birth cohort data; I am also enrolled on a course on path modelling at the University of Cambridge to aid with the data analysis for this study.
Outside of my PhD projects, I have continued to be engaged in teaching in an undergraduate statistic module and completed an assignment to gain associate fellowship of the Higher Education Academy. I have also collaborated with a couple of Masters students on different projects. For one of these, we have submitted the following article for publication:
Rozanski, S., Schmidt, A., John, A.; Gaysina, D. (in press) Childhood neglect and trajectories of affective symptoms throughout adulthood: a British birth cohort study, Journal of Affective Disorders.
I have also continued my voluntary work as a befriender for elderly people, which has continued to be very insightful and rewarding.
Progress Report Year 1, 2020
Background to my PhD research
Worldwide, the human population is ageing and life expectancy is increasing. However, healthy life expectancy does not keep track with this development, and time spent in poor health has increased. Depression and anxiety are common amongst older adults and are linked with other health conditions and higher mortality. This places a burden on the older person, their carer and society as a whole.
The overarching aim of my PhD is to investigate risk and protective factors for depression and anxiety in older adults. Moreover, I aim to identify factors affecting engagement in and outcomes of psychological treatments for depression and anxiety in older people. Identification of these factors would be an important step to ensure protection and improvement of mental health in older adults and associated quality of life.
My first year has been very busy and engaging. In order to aid my transition from undergraduate to postgraduate study, I have enrolled and completed several Master-level courses on advanced research and statistical training. In order to strengthen my statistical knowledge further, I also engaged in teaching in a 1st year undergraduate statistic module. This has helped improve my confidence in using statistical software and I very much enjoyed the experience of supporting other students in their learning.
The first study of my PhD focuses on the comparison between older and working age adults in working age and older adults on access, waiting times and treatment outcomes in the Health in Mind Improving Access to Psychological Therapies (IAPT) services in East Sussex. I have been lucky to work with and learn from a visiting post-doctoral researcher from Norway – Dr Makalani Myrtveit. In this collaborative study, we utilised routinely collected data by the IAPT services, which comprised over 20,000 individuals and nearly 50,000 sessions over a four year period. Our preliminary findings indicate that older people benefit from treatment in IAPT services; both older age groups (65 – 74 and 75 and above) had shorter waiting times and higher recovery and reliable recovery rates compared to working age adults. Currently, I am in the process of drafting an article for publication.
The second study of my PhD is a systematic literature review, where I investigate predictors for treatment outcomes of psychological therapies for older adults. I have identified and agreed search terms and databases to be searched with my supervisors, and I am in the process of preparing the pre-registration protocol for the review. The review will cover common mental disorders and all available treatments for these offered in the IAPT services, covering both low-intensity treatments, such as self-guided help and high intensity treatments, such as cognitive behavioural therapy.
This year, I was accepted to present my research findings at two national conferences, however, these were postponed until next year due to the current situation. In addition, I have enjoyed participating in a public engagement day organised by Alzheimer’s Research UK. This was a great opportunity to engage with the public about the importance of mental health in older adults (see picture attached). Further, I have continued my voluntary work as a befriender for elderly people, which has been more important than ever in these challenging times.
In the next few months, I plan to focus on the systematic literature review to synthesise findings on predictors for treatment outcomes.
Following findings of my systematic literature review, planning will commence on the design for my larger study looking at predictors for treatment outcomes for older people accessing IAPT treatment. Due to the current situation, the initial plans for participant recruitment and data collection will have to be adapted and alternative methods found, such as online or via telephone interview. It is also planned to apply for adoption of the study into the National Institute for Health Research (NIHR) portfolio, which will be immensely beneficial to the recruitment and running of the study. As this is a rather lengthy process planning for this is going to start shortly in order to start recruitment this time next year.
Further, I also plan to conduct a study on predictors for development and trajectories of depression and anxiety in older people using existing birth cohort resources. I will utilise a life-course approach using longitudinal data from the National Survey of Health and Development (NSHD), the oldest birth cohort in the UK.