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Precision Assignment to Psychosocial Interventions for Late-Life Depression: An Automated Treatment Decision Rule.
Nili Solomonov1, Daniel Kerchner2,3, Oded Bein1
1Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, New York, New York.
JAMA Psychiatry
|September 17, 2025
Summary
A new treatment decision rule (TDR) helps assign older adults to the best depression treatment, improving outcomes. This rule guides therapy or usual care, increasing effectiveness for late-life depression.
Area of Science:
- Geriatrics
- Psychiatry
- Clinical Psychology
Background:
- Older adults with depression face limited access to effective psychotherapies due to clinician shortages.
- Current treatment response rates for late-life depression are approximately 50%.
Purpose of the Study:
- To develop a scalable treatment decision rule (TDR) for assigning older adults to psychotherapy or usual care for late-life depression in community settings.
Main Methods:
- A prognostic study involving adults aged 60+ with major depression from randomized controlled trials.
- Participants received psychotherapy or usual care; a TDR was generated based on baseline characteristics to optimize intervention assignment.
- Primary outcome measured was depression severity reduction using the Hamilton Depression Rating Scale (HAM-D).
Main Results:
- The TDR predicted a 49.1% mean reduction in HAM-D scores, outperforming usual care (36.6%) and assigning all patients to psychotherapy (46.7%).
- The TDR identified specific patient profiles benefiting from psychotherapy (higher severity, stronger social support, lower cognition) versus usual care (lower severity, higher cognition, low social support).
Conclusions:
- The developed TDR can inform treatment assignment for late-life depression in community settings, potentially increasing precision and cost-effectiveness.
- Pending prospective validation, this TDR shows promise for improving treatment response rates in older adults with depression.
