Nursing Research: Problem Solving Intervention for Depression

This report examines evidence-based nursing research focusing on the effectiveness of problem-solving interventions for reducing depression symptoms in older adults. The research question explores whether problem-solving interventions can reduce depression in this demographic within two months compared to usual care. The report reviews a randomized controlled trial by Stahl et al. (2014), highlighting the study's design, methodology, ethical considerations, and findings, which indicated higher remission rates with problem-solving interventions. The literature review synthesizes three articles, including studies by Reynolds et al. (2014) and Choi et al. (2014), comparing problem-solving therapy with other interventions like pharmacological treatments and reminiscence therapy. The report concludes with recommendations for future research, emphasizing the need to consider combined healthcare interventions and the patterns of remission for more effective treatment strategies. An annotated bibliography is included, summarizing key research articles.

Running head: Evidence Based Nursing Research
Evidence Based Nursing Research
Name of the Student
Name of the University
Author note

1Evidence Based Nursing Research
PICO(T) question
The research question for this assignment will be:
Does problem solving intervention compared to usual care process is able to reduce
the depression symptoms in older adults with no visible secondary health condition within
2 months of application?
As per the Andersson & Titov (2014), mental health and especially depression is one of
the major concerns for the healthcare authorities of Australia as in 2 in every 4 people is
suffering from depression, anxiety and other mental health conditions nowadays. Therefore, this
research question was chosen to determine the effectiveness of the intervention which is useful in
reducing the symptoms related to depression within 2 months of period. In this aspect
comparison between usual intervention and problem soling intervention will be carried out.
Evaluation of research
The primary research article which will be chosen for this aspect is by Stahl et al. (2014).
The aim of the research was to conduct a study where problem solving therapy is applied with
that of another effective therapy in older patients suffering from depression as the population is
generally is resistant to antidepressant drugs (Garand et al., 2014). The research design which
was undertaken for this assessment, is the two site randomized controlled trial and the selected
population were people with 60 years and above and they were randomly assigned to a usual
intervention and the problem solving intervention and they were assessed in week 3,6,9 and 12.
In this research from 653 participants only 221 were selected for the analysis as they met the
inclusion criteria and hence, on them the selected interventions were carried out (Cuijpers et al.,

2Evidence Based Nursing Research
2014). After the research it was found that maximum rate of remission was achieved in the week
9 and 12 in the group on which problem solving intervention was carried out and the rate was
36.9% in week 9 and 45.6 % in week 12. The researchers followed the ethical consideration
while conducting the research as they maintained the anonymity of the randomized control trail
and eliminated the manual bias from the research process (Cuijpers et al., 2014). Besides the
finding section of the article successfully summarized the complete research process and
associated results in the section. Therefore, the paper successfully included each aspect of the
primary research (Choi et al., 2014).
Research topic
This systematic review paper deals with the problem solving intervention for the
depression affected individual and hence, it is important to discuss the effectiveness of the
problem solving intervention for depression and anxiety management. The research topic deals
with the problem solving therapy and its effectiveness in helping people with mental illness (van
der Aa et al., 2014). As per Keefe et al. (2014), t is a well-established and an evidence based
intervention that helps people to get effective treatment and care as the primary target of the
intervention is the anxiety and comorbid situation. As the research topic is comparison between a
usual healthcare intervention and the problem solving interventions for patients affected with
depression in controlling and managing the depression condition, Garand et al. (2014) mentions
that this intervention is helpful in managing the patient condition than cognitive behavioral or
pharmacological interventions as it helps to remove the doubts and concerns of patients.
The problem solving session could have been of any format such as questionnaire or
booklet using which people of the old age can understand use them to share their distress and
tension with healthcare professionals around them (Keefe et al., 2014). Therefore, it provides an

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easy way to communicate the depression and stress to healthcare professionals, which the other
healthcare professionals cannot provide to the patients. Further, in this intervention, it is easier to
assess the patient improvement or any further scope of improvement, which is not possible for
other healthcare or mental interventions for people affected with depression. Hence, this
intervention was used as a research question for this assessment (Andersson & Titov, 2014).
Literature review
In this literature review section, the three articles selected as the evidences to find the
answer to the research question will be critically discussed with reference of other literatures
(van der Aa et al., 2013). In this context it should be mentioned that there is very few evidences
available over internet regarding the comparison study between the usual intervention and
problem solving interventions for depression and hence, these three articles were selected for the
literature review, having two randomized control trial related study and a comparative study so
that the authenticity and reliability of the literature review could be increased (Garand et al.,
2014).
The first article is by researchers Stahl et al. (2014), who aimed to find the effect of
problem solving interventions in increasing the participants ability to take part in their diet
preparation session after being aware of the problem solving session (Moyer, 2013). Hence, the
patients were more than 60 years of age and took part in the randomized control trial. For this
process the researchers finalized more than 8 healthcare facilities with 18 primary care clinics
and selected more than 1800 patients with age 60 and above to take part in the research (Stahl et
al, 2014). The interventions they compare for patients was the problem solving therapy and a
pharmacological therapy or medication such as antidepressant to make the patient condition

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better. It was found from the research that with diet management intervention was determined to
the patients to improve their depression and pain management (Cuijpers et al., 2014).
The second research was conducted by Reynolds et al. (2014) in which the researchers
aimed to find out the effect of this intervention on patients who are back and white or of various
ethnicity and for this purpose, they conducted the study on 153 white patients and 90 black
patients who were selected from 653 people and took part in the randomized control trail and
implemented intervention on them for 12 weeks. As the assessment was carried 3, 6 9 and 12th
week, it was found that patients undergoing problem solving intervention in 9th and 12th week
were able to show maximum remission and hence, determined the effectiveness of the
intervention (Moyer, 2013). This result was effective as the patients who were provided with the
intervention was resistant to anti-depressants and problem solving intervention was the only
intervention that could have been employed in those patients. Hence, it was compared with such
pharmacological intervention and provided a positive result as remission of 20% depression
using the intervention was a big achievement for the researchers (Reynolds et al., 2014).
The third research article chosen for this literature review was by the Choi et al. (2014)
and the primary aim of this research was to find out the comparative result between two therapies
such as the problem solving therapy and the reminiscence therapy while treating depression
condition in older adults, who are homebound with age 60 and above. In this research the
participants were assigned to these two interventions randomly and a control group with no
implemented intervention was kept to compare the effectiveness of the intervention (Choi et al.,
2014). The participants were first assessed for their pre-treatment and then after implementation
of the intervention the follow up was taken after three months and after the complete research it
was found that group who was having problem solving intervention as their depression

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management therapy shown maximum rate of remission from their chronic depression condition
as compared to the control group (Cuijpers et al., 2014). Whereas, the group receiving the
reminiscence therapy also shown growth in the depression condition however, the rate was quite
lower than that of the problem solving intervention. Therefore, this lietarture review was able to
provide justified answer to the research question (Reynolds et al., 2014).
Recommendations for future research
The future research should assess the scope of amalgamation of healthcare interventions
for primary and secondary health condition as using this the patient condition could be improved
quickly. In the research by Stahl et al. (2014) patients of were affected with depression as well as
a secondary health condition and hence, researchers had to leave one of the health condition
untreated because it could affect the other health condition The second thing which could be
recommended from the detailed study of these literature that the researchers should focus on the
pattern of remission so that interventions could be designed as per the pattern and mode of
remission to make it more easier and accessible to reach.

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References
Andersson, G., & Titov, N. (2014). Advantages and limitations of Internet‐based interventions
for common mental disorders. World Psychiatry, 13(1), 4-11.
Choi, N. G., Marti, C. N., Bruce, M. L., Hegel, M. T., Wilson, N. L., & Kunik, M. E. (2014).
Six‐month postintervention depression and disability outcomes of in‐home telehealth
problem‐solving therapy for depressed, low‐income homebound older adults. Depression
and anxiety, 31(8), 653-661.
Cuijpers, P., Karyotaki, E., Pot, A. M., Park, M., & Reynolds III, C. F. (2014). Managing
depression in older age: psychological interventions. Maturitas, 79(2), 160-169.
Garand, L., Rinaldo, D. E., Alberth, M. M., Delany, J., Beasock, S. L., Lopez, O. L., ... & Dew,
M. A. (2014). Effects of problem solving therapy on mental health outcomes in family
caregivers of persons with a new diagnosis of mild cognitive impairment or early
dementia: a randomized controlled trial. The American Journal of Geriatric
Psychiatry, 22(8), 771-781.
Keefe, F. J., Porter, L., Somers, T., Shelby, R., & Wren, A. V. (2013). Psychosocial interventions
for managing pain in older adults: outcomes and clinical implications. British journal of
anaesthesia, 111(1), 89-94.
Moyer, V. A. (2013). Screening for intimate partner violence and abuse of elderly and vulnerable
adults: US preventive services task force recommendation statement. Annals of internal
medicine, 158(6), 478-486.

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Reynolds III, C. F., Thomas, S. B., Morse, J. Q., Anderson, S. J., Albert, S., Dew, M. A., ... &
Stack, J. A. (2014). Early intervention to preempt major depression among older black
and white adults. Psychiatric services, 65(6), 765-773.
Stahl, S. T., Albert, S. M., Dew, M. A., Lockovich, M. H., & Reynolds III, C. F. (2014).
Coaching in healthy dietary practices in at-risk older adults: a case of indicated
depression prevention. American Journal of Psychiatry, 171(5), 499-505.
van der Aa, H. P., Van Rens, G. H., Comijs, H. C., Bosmans, J. E., Margrain, T. H., & van
Nispen, R. M. (2013). Stepped-care to prevent depression and anxiety in visually
impaired older adults–design of a randomised controlled trial. BMC psychiatry, 13(1),
209.

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Appendix (Annotated bibliography)
Stahl, S. T., Albert, S. M., Dew, M. A., Lockovich, M. H., & Reynolds III, C. F.
(2014). Coaching in healthy dietary practices in at-risk older adults: a case of indicated
depression prevention. American Journal of Psychiatry, 171(5), 499-505.
In this research article the primary aim of the researchers to determine the usage of
problem solving intervention in making them aware of their depression condition and help them
to prepare their own diet practice to prevent their depression condition. In this factor, the
researchers conducted educational sessions, and dietary coaching program with the patients and
it was found that the intervention was able to provide help to the older adults by remission of
50% of depression rates in those participants. Therefore, the research was able to provide
effective ness of problem solving therapy in making people aware of their health condition.
Reynolds III, C. F., Thomas, S. B., Morse, J. Q., Anderson, S. J., Albert, S., Dew, M.
A., ... & Stack, J. A. (2014). Early intervention to preempt major depression among older
black and white adults. Psychiatric services, 65(6), 765-773.
The primary role of this research was to find out the efficacy of problem solving
intervention in patients admitted in primary care facility and compare that to usual interventions
to find the effectiveness of it. In this research 90 black and 153 white participants were included
in the randomized control trail and then with intervention and then provide them with
interventions so that its effectiveness could be assessed. It was found that the problem solving
intervention was able to provide a remission of 20% in adults who were assigned to the target
intervention and hence the research question was addressed.

9Evidence Based Nursing Research
Choi, N. G., Marti, C. N., Bruce, M. L., Hegel, M. T., Wilson, N. L., & Kunik, M. E.
(2014). Six‐month postintervention depression and disability outcomes of in‐home
telehealth problem‐solving therapy for depressed, low‐income homebound older
adults. Depression and anxiety, 31(8), 653-661.
This research targeted the homebound older people who were not able to take part in the
healthcare interventions in the healthcare facility and took part in the problem solving sessions to
combat their depression condition. Interventions such as tele‐PST via Skype video call and other
sessions were selected for low‐income homebound older adults over 6 months post intervention.
The population targeted in the study was included in the 3 am randomized controlled trail.
Therefore, it was found that people who received the problem solving therapy in tele
communication was able to receive help after the session.