With Singapore’s ageing population, it was anticipated that the increasing number depressed elderly would make recurrent and expensive demands on old age services. There were evidence-based studies that demonstrated the benefits of group therapy in older people with depression, anxiety, low self-esteem and maladaptive behaviour. Aside from being cost effective, group therapy can be more helpful than individual therapy when social support and learning about interpersonal difficulties are objectives of treatment. This paper described the process of setting up and running an outpatient support group for depressed elderly in the psychiatric setting and highlighted the challenges encountered.

English-speaking subjects > 65 years old with a diagnosis of depressive disorder (ICD-10) with no significant cognitive impairment were recruited. Participants attended a weekly closed group for 12 consecutive weeks with each session lasting 75 minutes. Participants continued with their treatments offered by their psychiatrists. The content of the discussion was determined by the group members. Discussion notes were taken by the facilitators after each session. Depression and well-being rating scales were used to assess depression severity at baseline and at the end of 12 weeks.

The response for the study was poor with reluctance to participate in group treatment despite attempts made by the department to encourage participation. 8 participants were eventually enrolled with 3 dropouts. Attendance was disrupted due to sickness, medical appointments, hospitalizations and grandparenting duties. There was a trend of improvement in the evaluation scores of the participants. The main themes identified were (1) ageing and health concerns; (2) reminiscence of the past; (3) regrets and burdens; (4) strategies to defeat depression. Group dynamics observed included universality of painful experiences, mirroring of common experiences during Japanese occupation and strong pairing of the same gender. There were no re-admissions or suicide attempts during the study period.

The lack of response to group work amongst the elderly was consistently observed in this study. This contrasted with the popularity of such interventions in non-Asian settings. Further research would help to elucidate the cultural reluctance in sharing psychological problems amongst the elderly within a psychiatric setting.