Effectiveness of an age-modified mindfulness-based cognitive therapy (MBCT) in improving mental health in older people with depressive symptoms: a non-randomised controlled trial

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Abstract

Background

Emerging evidence has shown that mindfulness-based cognitive therapy (MBCT) is effective in improving depressive symptoms in the older population. However, the accessibility to MBCT is limited by the shortage of psychotherapists or mindfulness teachers. One potential solution is to involve social workers, who have the knowledge and skills to promote individual and community well-being in various settings, in delivering modified MBCT to enhance its accessibility and sustainability. This study examined the effectiveness of an eight-week age-modified MBCT led by different mental health professionals (mindfulness teacher only vs. mindfulness teacher and social worker) in improving mental health outcomes as compared with a control group.

Methods

Older adults ( N = 112) were recruited through five community-based centres for older adults and mental wellness in Hong Kong. Participants were allocated to one of three groups: (1) mindfulness teacher-led modified MBCT, (2) social worker/teacher co-led modified MBCT (50% led by social workers and 50% led by mindfulness teacher), or (3) control (care as usual). The age-modified MBCT consisted of eight weekly sessions, with age-related modifications including more sitting meditation, shortened duration of each session, and the removal of the retreat. Outcome variables (i.e., depressive symptoms, anxiety symptoms, perceived stress, and mindfulness) were assessed at baseline (T0), after the intervention (T1), and four weeks after the intervention (T2), through self-reported questionnaires. Linear mixed models were performed while controlling for demographic variables to examine changes in outcome variables between the groups.

Results

Participants from the age-modified MBCT intervention groups (teacher-led and social worker/teacher co-led) showed significantly greater reductions in depressive symptoms and stress, as well as greater increase in mindful non-reactivity, compared to the control group post-intervention. No significant interaction effect of time and group was found for anxiety and both overall mindfulness and its other facets. The improvements in mental health and mindfulness outcomes post-intervention were not significantly different between the teacher-led and social worker/teacher co-led MCBT groups.

Discussion

Age-modified MBCT is beneficial in managing depressive and stress symptoms and in improving mindful non-reactivity among older adults at risk for depression. The findings support the feasibility and effectiveness of partial task-shifting in the delivery of MBCT to trained social workers. Future studies may explore the possibility for social workers in leading MBCTs independently to further improve its scalability and service accessibility for older adults in the community.

Trial registration

ClinicalTrials.gov NCT05995587. Retrospectively registered on 16 August 2023.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-025-04781-6.

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Most cited references 54

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A brief measure for assessing generalized anxiety disorder: the GAD-7.

Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J B Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Spencer L James, Degu Abate, Kalkidan Hassen Abate … (2020)

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Funding Bill & Melinda Gates Foundation.

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Author and article information

Contributors

Dara Kiu Yi Leung:

ORCID: http://orcid.org/0000-0002-7255-2790

daralky@hku.hk

Journal

Journal ID (nlm-ta): BMC Complement Med Ther

Journal ID (iso-abbrev): BMC Complement Med Ther

Title: BMC Complementary Medicine and Therapies

Publisher: BioMed Central (London )

ISSN (Electronic): 2662-7671

Publication date (Electronic): 26 February 2025

Publication date PMC-release: 26 February 2025

Publication date Collection: 2025

Volume: 25

Electronic Location Identifier: 81

Affiliations

[1 ]Department of Psychology, National Taiwan University, ( https://ror.org/05bqach95) Taipei, Taiwan, Republic of China

[2 ]Department of Counseling, Clinical and Industrial/Organizational Psychology, Ming Chuan University, ( https://ror.org/02pgvzy25) Taoyuan City, Taiwan, Republic of China

[3 ]Department of Social Work and Social Administration, The University of Hong Kong, ( https://ror.org/02zhqgq86) Hong Kong, SAR China

[4 ]Department of Applied Social Sciences, The Hong Kong Polytechnic University, ( https://ror.org/0030zas98) Hong Kong, SAR China

[5 ]School of Psychology and Clinical Language Sciences, University of Reading, ( https://ror.org/05v62cm79) Reading, England

[6 ]Sau Po Centre on Ageing, The University of Hong Kong, ( https://ror.org/02zhqgq86) Hong Kong, SAR China

Author information

Yun-Han Wang http://orcid.org/0000-0001-9721-0941

Yun-Lin Wang http://orcid.org/0000-0002-4772-6154

Dara Kiu Yi Leung http://orcid.org/0000-0002-7255-2790

Stephanie Ming Yin Wong http://orcid.org/0000-0002-9535-9846

Tianyin Liu http://orcid.org/0000-0002-8194-5342

Gloria Hoi Yan Wong http://orcid.org/0000-0002-1331-942X

Terry Yat Sang Lum http://orcid.org/0000-0003-1196-5345

Article

Publisher ID: 4781

DOI: 10.1186/s12906-025-04781-6

PMC ID: 11863447

PubMed ID: 40011881

SO-VID: a2d8f053-69dc-4135-b142-f09806b9b119

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 2 March 2024

Date accepted : 23 January 2025

Funding

Funded by: The Hong Kong Jockey Club Charities Trust.

Custom metadata

Keywords: mindfulness-based cognitive therapy,older adults,depression,anxiety,stress,mindfulness,social workers

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Keywords: mindfulness-based cognitive therapy, older adults, depression, anxiety, stress, mindfulness, social workers

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Effectiveness of an age-modified mindfulness-based cognitive therapy (MBCT) in improving mental health in older people with depressive symptoms: a non-randomised controlled trial

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Abstract

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Discussion

Trial registration

Supplementary Information

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Most cited references 54

A brief measure for assessing generalized anxiety disorder: the GAD-7.

The PHQ-9: validity of a brief depression severity measure.

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

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