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A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial.

ABSTRACT: Effective care models for treating older African Americans with depressive symptoms are needed.To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680).A senior center and participants' homes from 2008 to 2010.African Americans aged 55 years or older with depressive symptoms.A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months.Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months.Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, -2.9 [95% CI, -4.6 to -1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, -3.7 [CI, -5.4 to -2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months.The study had a small sample, short duration, and differential withdrawal rate.A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans.National Institute of Mental Health.

SUBMITTER: Gitlin LN

PROVIDER: S-EPMC4091662 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial.

Gitlin Laura N LN Harris Lynn Fields LF McCoy Megan C MC Chernett Nancy L NL Pizzi Laura T LT Jutkowitz Eric E Hess Edward E Hauck Walter W WW

Annals of internal medicine 20130801 4

<h4>Background</h4>Effective care models for treating older African Americans with depressive symptoms are needed.<h4>Objective</h4>To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.<h4>Design</h4>Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680).<h4>Setting</h4>A senior center and participants' homes ...[more]

PMID: 24026257

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Project description:BACKGROUND:Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (??70 years) using personal support services. METHODS:A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients', nurses', and personal support workers' perceptions about the intervention's appropriateness, benefits, and barriers and facilitators to implementation. RESULTS:Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. CONCLUSIONS:Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT01407926.

Project description:Background and objectivesFamily ties and role relationships through their effects on exchanges of resources and social support are critical health contexts for older African Americans. We studied the influence of affect-based (positive or negative) social relations and respondent-role network centrality on depressive symptoms in older African Americans compared to two ethno-racial groups, Black Caribbeans and Non-Hispanic Whites.Research design and methodsWe used data from the multigenerational 2004 National Survey of American Life Family Connections across Generations and Nations Study (NSAL 3-Gen). For respondents aged 50 years or older, we used tie affect (positive or negative) to code family role relations and two-mode (where an entity or thing is connected to a different type of entity, here individuals are connected to role relations) family networks. We used survey linear regressions to probe the independent association of relations and networks on depressive symptoms among older African Americans as compared to Black Caribbeans and Non-Hispanic Whites.ResultsNegative and positive relations are significantly associated with depressive symptoms, but there were some ethno-racial differences. For example, the negative Father relation is significantly associated with greater depressive symptoms among African Americans, but not in Black Caribbeans and Non-Hispanic Whites. Negative two-mode networks (connections from individuals to role relations) are significantly associated with depressive symptoms among African Americans and in the two comparison ethno-racial groups, while there is no significant association between positive networks and depressive symptoms.Discussion and implicationsWe found that negative relations had larger effects on depressive symptoms than positive ones, and conversely that negative networks had larger effects than positive networks. Simultaneously modeling social relations and networks could potentially enhance our understanding of the links between social structure, and depressive symptoms among older adults in African American and other ethno-racial minorities.

Project description:BackgroundPrimary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness.Methods/designBeat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55+ years old. It involves a collaboration with a senior center whose care management staff screen for depressive symptoms (telephone or in-person) using the Patient Health Questionnaire (PHQ-9). Individuals screened positive (PHQ-9 ≥ 5) on two separate occasions over 2 weeks are referred to local mental health resources and BTB. Interested and eligible participants who consent receive a baseline home interview and then are randomly assigned to receive BTB immediately or 4 months later (wait-list control). All participants are interviewed at 4 (main study endpoint) and 8 months at home by assessors masked to study assignment. Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs, make referrals/linkages, provide depression education, instruct in stress reduction techniques, and use behavioral activation to identify goals and steps to achieve them. Key outcomes include reduced depressive symptoms (primary), reduced anxiety and functional disability, improved quality of life, and enhanced depression knowledge and behavioral activation (secondary). Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions. Cost and cost effectiveness is being evaluated.DiscussionBTB is designed to bridge gaps in mental health service access and treatments for older African Americans. Treatment components are tailored to specific care needs, depression knowledge, preference for stress reduction techniques, and personal activity goals. Total costs are $584.64/4 months; or $146.16 per participant/per month.Trial registrationClinicalTrials.gov #NCT00511680.

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A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial.

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A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial.

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