Effect of trauma-focused cognitive behavior therapy on depression and the quality of life of the elderly in Indonesia

Purpose: This study aimed to analyze the effect of Trauma-Focused Cognitive Behavior Therapy (TF-CBT) on the depression level and quality of life of the elderly in an earthquake-affected district of North Lombok Regency, Indonesia. Design/methodology/approach: A Randomized Controlled Trial (RCT) with a population of two elderly groups living in an earthquake-affected district was used in this study. The intervention comprised giving TF-CBT. There were three research instruments applied to determine the variables, namely, the Clinician-Administered PTSD Scale (CAPS-5), the Geriatric Depression Scale 15 (GDS 15) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). All instruments were adopted and translated using back translation to Bahasa Indonesia, which is appropriate at the suggestion of the WHO. To investigate the effect of the intervention, we used hierarchical linear models (HLM) with intent-to-treat analysis. The patent parameter effect was tested using the Wald test (t-test) with a confidence Interval of 95 per cent. Findings: The final analysis applied CAPS-5 and showed that there was a decrease in the PTSD of the respondents, which was down to only 8 (17.8 per cent) in the post-test. The same situation happened for the depression variable (2.8 per cent) after it was assessed using GDS-15C. The Quality of life (WHOQoL-BREF) variable was divided into Physical (50.7), Psychological (57.1), Social (53.6) and Environmental (45.7). These components show there to be a significant result in terms of improving the quality of life of the elderly victims of the earthquake. The finding highlights that applying TF-CBT in the elderly population can significantly drop post-traumatic stress disorder and depression level and enhanced quality of life. Social implications: The intervention decreased the depression level and improved the quality of life of the elderly as found in the six- week follow-up. Longer training and integration with the structured local wisdom could be necessary to better address the mental health of the elderly affected by the earthquake. Moreover, strengthening the role of the family as the primary caregiver is required to improve the outcome. Originality/value: This is the first study that has attempted to use TF-CBT as a method of treatment for the elderly to decrease their depression and to increase quality of life among the Indonesian elderly who have experienced an earthquake. This paper provides knowledge on the effectiveness of TF-CBT that can be used by therapists to treat depression problems suffered by the elderly in a post-disaster area.