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The Relationship Between Homework Compliance and Treatment Outcomes Among Older Adult Outpatients With Mild-to-Moderate Depression

Received December 20, 2001; revised October 2, October 25, 2002; accepted October 28, 2002. From the Institute on Aging, San Francisco, CA (DWC), the Older Adult and Family Center, VA Palo Alto Health Care System and Stanford University School of Medicine (DWC,LWT), and the Pacific Graduate School of Psychology, Palo Alto, CA (LWT). Address correspondence to Dr. Coon, Institute on Aging, 3330 Geary Blvd., 2 East, San Francisco, CA 94118. e-mail: dcoon{at}ioaging.org

OBJECTIVE: The authors extend previous research on homework in psychotherapy by examining the relationship between homework compliance and therapeutic outcome among depressed older adult outpatients (N=63), addressing previous limitations by using session-by-session therapist ratings of homework compliance and including both interviewer ratings and patient self-reports of outcomes. METHODS: Patients were participants in a randomized clinical trial evaluating the efficacy of desipramine versus cognitive/behavioral therapy-alone (C/B-Alone) versus a combination of the two (Combined). Given the current study's focus on homework compliance, only patients assigned to conditions with assigned homework in the clinical trial (i.e., C/B-Alone and Combined conditions) were included. RESULTS: Results of hierarchical regression analyses indicated that homework compliance contributed significantly to posttreatment outcome as measured by both interviewer-administered and patient self-report measures of depression. A separate series of ANOVAs also found significant differences in pre–posttreatment change between patients scoring above and below the median of reported homework compliance. Findings were similar for patients in the C/B-Alone and Combined conditions. CONCLUSION: The study's results call for additional research on issues related to homework compliance with older adult patients.

Key Words: Depression • Cognitive Therapy • Treatment Compliance

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