Introduction
This paper reviews the article titled, “Effectiveness of integrative and instrumental reminiscence therapies on depression symptoms reduction in institutionalized older adults: An empirical study” by Karimi et al. (2010) and published in the journal of ‘Aging and Mental Health 14(7), 881-887’. This article presents the research findings of a study conducted in Iran to assess how effective integrative, as well as instrumental reminiscence therapies are in the management of depression in older persons.
There was a major focus on reduction of the symptoms of depression. Numerous studies on this study topic have been conducted, and while some appear to affirm the impact of these reminiscence interventions, there are many cited inconsistencies. This study sought to venture into this area in an attempt to support, disapprove or even come up with new findings on this topic of study.
Justification/ problem statement
The study sets off with a study topic that is extensively expounded in the background/literature review section, substantially supported by numerous recent citations from previous studies on this topic. The study is justified by the fact that a consideration of reminiscence in sub-categories and not as a unitary occurrence would perhaps provide acceptable findings, unlike previous studies; which is possibly the rationale behind the inconsistencies in these research findings.
Owing to this occurrence, previous studies failed to win enough reliability to facilitate substantial conclusions. Therefore, Watt and Wong (1991) proposed that the major reason behind these variances would be in the fact that reminiscence studies were conducted with an approach to reminiscence as one phenomenon; thus, they categorized it into integrative, instrumental, and escapist, among other categories. For that reason, this study chose to consider instrumental and integrative classes of reminiscence interventions singly.
Hypothesis/ purpose
The study hypothesized that integrative and instrumental therapies lower the symptoms of depression significantly in elderly adults. The abstract, concisely presented, provides the purpose of the study, which is deeply expounded in the introduction section with heavy support from varied citations. This helped in assessing the effectiveness of integral reminiscence intervention and instrumental reminiscence intervention in lowering depression symptoms in adults, particularly those in nursing homes. The abstract further summarizes the methodology, the findings and a conclusion, thus giving the reader an overview of the study.
Study Design
Participants
One hundred and nine people (109) from Kagrizak Nursing Home volunteered for the study, but only 94 passed the initial interview from which only 48 were found eligible. Eligibility demanded that the subjects ought to have been in the nursing home for more than six months, be 60 years and above, not currently under depressants (or if they did, they had to have been stabilized on this therapy for three months and above), and should have been suffering from depression.
Thirty-nine participants (39) were randomly selected from the eligible ones, but 10 participants were left out for various reasons, including suffering from other illnesses or failing to attend 60% of the sessions. Thus, the research finally ended up studying 29 subjects, aged between 64 and 87 (12 males, 17 females). Nine participants were evaluated for instrumental reminiscence and ten were in the integrative reminiscence class. A control group (active social group of discussion) was selected to distinguish specific from general group effects. The evaluation was carried out by clinical psychologists (master’s degree holders) who were blind to the therapy of the participants.
Methods and materials
The participants were subjected to a MMSE interview (Iranian version) to assess their mental state, whereby a score less than 21 designated cognitive impairment. The GDS-15 was used to measure depression symptoms (to those who would not read due to low vision or illiteracy, the GDS-15 was performed by interview); the GDS-15 has 15 items of which ten are indicative of symptoms if answered in the affirmative, and the other five indicated depression when answered in the negative. The Iranian version of GDS-15 was used for this study.
The intervention manual of Watt and Cappelies (2000) was used to conduct these interventions, with slight adjustments on some materials to make them culturally fitting, as well as take care of those who were illiterate since most participants were not literate. Six 90-minute weekly sessions were carried out in the form of three groups, headed by a therapist with a master’s degree under the supervision of a clinical psychologist. Each week, participants were required to remember different themes, including history of their family, achievements in life, main life turning pints, love and hate history, affliction experiences, and life meaning among others.
Participants were further required to think on the following session’s topic as homework to make it easy for them to bring to mind the themes in the next session. The control group members participated in all the sessions, tackling topics like physical problems and how they influence daily lives, family association alterations, and older adults’ status based on the laws of religion as well as public, and challenges facing the young among other issues.
Data analysis
The researchers of this study used the ANCOVA test to draw the distinction between the pre-test scores and the post-test scores (with depression severity as the variable of covariate) of all the groups that were being studied. A p-value below 0.005 was considered statistically substantial. The ANCOVA test tested the possibility of other factors influencing the result of the variable that was being tested. The Scheffe post-hoc test was used to determine the most significant reminiscence intervention group from the three.
Results
The findings indicated that the post-test scores of the symptoms of depression of the three groups substantially disagreed after excluding the scores of pre-test (covariate). These results are duly summarized in a table, thus making it easy to understand and figure out this concept. Further, the most significant group (integrative) was explicitly determined by use of Scheffe post-hoc test, and the results are equally represented in another table. This makes for easy and conceptual grasp of these results.
A comparison of the integrative and the social groups revealed a distinct variance between the two, whereby the symptoms of depression among the integrative group were found to be substantially lower in comparison to those of the control. On the other hand, no substantial disparity was observed between the instrumental group and the control. These are overtly observable from a table presenting these findings. These findings, in combination, substantially indicate that integrative reminiscence therapy is more effective in depression symptom reduction compared to instrumental intervention.
Discussion
A statistically substantial reduction in the symptoms of depression in older adults was demonstrated by comparing a control group with the integrative group. These findings were in line with the research findings of previous studies conducted by Chin, (2007). Capppelieze and O’Rourke, (2006) conducted a study on the functions and consequence of reminiscence in general and found out a significant reduction of symptoms, which is also consistent with results of this study.
Therefore, it is right to say that integrative reminiscence therapy is clinically significant since it reduces depression symptoms in adults (Hsieh & Wang, 2003). The covariate variable, which represented the severity of depression, was found to be statistically substantial. This was also in line with the findings of Pinquart et al. (2007).
However, in the instrumental group, no statistically substantial reduction was found, despite the GDS-15 indicating a relative reduction. The mean score was 9.22 (pre-test), which falls within the moderate depression range, and 7.017 (adjusted post-test) implying mild depression. While this would be indicative of clinical significance, the Scheffe post-hoc test indicated that the effect was not statistically substantial. This differed slightly with the findings of Watt and Cappelieze (2000), who found out that there was a clinically significant reduction in depression symptoms ranging from moderate to high.
This study at first (six weeks) found out a significant improvement in depression symptoms in both interventions, but later (three months) the integrative reminiscence turned out more effective. However, Watt and Cappelieze (2000) stated that the results would not be overly reliable since they used a small sample size; this could somewhat validate the findings of Karimi et al. (2010) in the present study.
Further, the finding that the integrative reminiscence intervention is better than instrumental intervention is not consistent with the findings of Capppelieze, O’Rourke and Chaudhury (2006). The difference is attributed to the disparity in process components of these interventions; integrative intervention components appear familiar to the illiterate (major participants in the current study), while instrumental is best fitted for out of institutionalized adults. Moreover, the manual used for intervention evaluation was initially meant for use with the literate. Thus, it was first adapted to fit for use in this current study. Conceivably, further adaptation would yield different results altogether.
The authors justify the use of a small sample size, arguing that a large one would hamper sharing of the feelings of all the members of a group, and it would be difficult to create relationships and confidence in a large sample sized group. Nevertheless, the small sample size is considered to be a limitation, which spurs questioning of the results. Further, the study focused solely on a single variable, symptoms of depression, which is also a limitation.
Conclusion
Generally, this article follows a logical presentation of findings; the title, abstract, introduction, study design, results, discussion, conclusion, acknowledgement, and reference are all presented in the common order and as described above. The sections are also tackled extensively. The general language used is devoid of scientific and statistical jargon, which makes for easy comprehension of the whole study by both experts and non-experts. Results are presented in written form, coupled with tables for easy following.
The authors derived a lot from previous studies; which adds to the reliability and validity of their findings, besides the use of approved standard manual for evaluation. The fact that the findings were consistent with most previous findings and a rationale for any inconsistent determined also boosts reliability and validity of the study. It is can be observed that citations, besides being relevant, were recent. Most of them were from the year 2000 and above, and only a handful were from the 1990s.
The study sought to study the effect of instrumental and integrative therapies on depression symptoms, as well as test the hypothesis that both interventions significantly reduced depression symptoms. The study design employed apparently helped the achievement of all this as depicted in the wide discussion of the research findings presented in this article. It can, thus, be concluded that the research was successful. However, as suggested, a manual test adapted for use in particular situations is important, and larger sample sizes should be considered for better and consistent results in future studies.
References
Cappeliez, P., O’Rourke, N., & Chaudhury, H. (2005). Functions of reminiscence and mental health in later adulthood. Aging and Mental Health, 9(4), 295–301.
Chin, A. H. (2007). Clinical effects of reminiscence therapy in older adults: A meta-analysis of controlled trials. Kong Journal of Occupational Therapy, 17(1), 10–22
Hsieh, H. F., & Wang, J. (2003). Effect of reminiscence therapy on depression in older adults: A systematic review. International Journal of Nursing Studies, 40(4), 335–345.
Karimi, H., Dolatshahee, B., Momeni, K., Khodabakhshi, A., Rezaei, M., & Kamrani, A. A. (2010). Effectiveness of integrative and instrumental reminiscence therapies on depression symptoms reduction in institutionalized older adults: An empirical study. Aging and Mental Health 14(7), 881-887
Pinquart, M., Duberstein, P. R., & Lyness, J. M. (2007). Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: A meta-analysis. Aging and Mental Health, 11(6), 645–657
Watt, L. M., & Cappeliez, P. (2000). Integrative and instrumental reminiscence therapies for depression in older adults: Intervention strategies and treatment effectiveness. Aging and Mental Health, 4(2), 166–177.
Watt, L. M., & Wong, T. P. (1991). A taxonomy of reminiscence and therapeutic implications. Journal of Gerontological Social Work, 16(1-2), 37–57.