LOS ANGELES – Poor executive function ability in older patients with major depressive disorder was associated with reduced ability to implement emotion-regulation strategies in a prospective study involving 70 subjects.
The findings suggest that older patients with poor executive functioning might have a reduced capacity for benefiting from standard interventions for depression, such as cognitive-behavioral therapy, which rely on the implementation of emotion-regulation skills, Moria J. Smoski, Ph.D., reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.
A total of 70 adults aged 60-87 years – 30 with major depressive disorder (MDD) and 40 without MDD – participated in the study. All subjects completed an emotion-regulation task involving stress induction achieved by ruminating for 2 minutes about a personally relevant stressor, followed by guided emotion regulation by either reappraisal or distraction techniques. A control group received no instruction on emotion regulation, said Dr. Smoski of Duke University Medical Center, Durham, N.C.
Mood was assessed using a three-item scale administered before and after stress induction, and at 1-minute intervals throughout the emotion-regulation phase. This protocol was repeated three times.
A subset of participants underwent neuropsychological executive-function testing, including a verbal fluency test (FAS) and assessment of task-switching and cognitive flexibility using the Trail Making Test-B (Trails B), Dr. Smoski said in an interview.
Subjects with MDD who had mid-level Trails B scores (scores at the 34th to 66th percentile) or high-level scores (scores at the 67th to 100th percentile) – indicating adequate or high levels of executive functioning – experienced significantly different degrees of negative affect reduction based on the emotion-regulation strategy used. The greatest decrease in negative affect scores was seen in those instructed to use distraction, followed by those instructed to use reappraisal and those who received no instruction on emotion regulation.
Subjects with low-level Trails B scores (scores at the 0 to 33rd percentile) – indicating poor executive function ability – experienced no benefit with use of any of the regulation strategies, Dr. Smoski said.
No Trails B–dependent effects were seen among those without MDD.
"Participants with low executive function ability may have less ability to capitalize on conscious emotion regulation–strategy use to manage negative affect," she noted.
The findings indicate that executive function moderates emotion regulation in late-life depression and might have important implications for treatment in this population, Dr. Smoski said.
Since patients with late-life depression and poor executive function may have reduced response to standard interventions, referral for behavioral-activation therapy – a "promising and interesting treatment approach" – merits consideration, she said.
This study was supported by grants from the National Institutes of Health. Dr. Smoski reported having no other disclosures.