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Sampson M, Yu M, Mauldin R, Gonzalez L, Mayorga AN. Home Visits for Postpartum Depression Intervention among Low-Income Latinas: Results from the PST4PPD Project. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:141-155. [PMID: 38445907 DOI: 10.1080/19371918.2024.2319862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Research shows that U.S. Latinas are at risk for high rates of postpartum depression (PPD) but have low rates of treatment compared to non-Hispanic White mothers. This study examined the feasibility of a multi-site home-visiting intervention (PST4PPD) conducted by bilingual community health workers (CHW) among low-income Latina mothers. A one-group, pre/posttest design and paired sample's t-test were used to measure changes in depressive symptoms and self-efficacy for participants (n = 76) across five sites. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were used to assess depression; the New General Self-Efficacy Scale and the Maternal Efficacy Questionnaire measured general self-efficacy and parenting self-efficacy. Depression scores decreased significantly from pretest to posttest. Participants' general self-efficacy, maternal self-efficacy, and PPD knowledge increased. With a 76% completion rate, demonstrable improvements were seen in participants' depression and self-efficacy. Implications for addressing modifiable factors such as self-efficacy and stress management are discussed.
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Affiliation(s)
- McClain Sampson
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Miao Yu
- Graduate College of Social Work, University of Houston, Houston, USA
| | - Rebecca Mauldin
- School of Social Work, The University of Texas at Arlington, Arlington, USA
| | | | - Angie N Mayorga
- Clinical Psychology Department, University of Houston, Houston, USA
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Hollister B, Crabb R, Kaplan S, Brandner M, Areán P. Effectiveness of Case Management with Problem-Solving Therapy for Rural Older Adults with Depression. Am J Geriatr Psychiatry 2022; 30:1083-1092. [PMID: 35379537 DOI: 10.1016/j.jagp.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the effect of case management with problem solving therapy (CM-PST) on depression and disability among rural older adults and compare its effect with outcomes derived from a previous, but similar study among 84 urban older adults. METHODS This study examined the comparative effectiveness of a CM-PST intervention for older adults with depression and unmet needs across rural and urban settings. Participants received 12 one-hour sessions of CM-PST with a master's-level clinician. A total of 56 rural and 84 urban adults aged 60 and older experiencing mild to moderate depression received services in their homes. RESULTS The rural CM-PST intervention resulted in significantly reduced depression (reduction of 13.9 points, 95% CI 12.2 to 15.7, t(422)= 15.35, p<0.0001) and disability by week 12 (reduction of 6.7 points, 95% CI 4.8 to 8.5, t(425)= 7.01, p<0.0001). Reductions in depression and disability were sustained through week 24. The reductions in depression (F=3.98 df=4,388. p=0.0035) and disability (F=2.71, df=4,381, p=0.03) found in the rural sample were comparable to, or better than, those found in the urban sample. Improvements in unmet need and resilience predicted lower depression scores at 12 weeks, while improvements in unmet need and hopelessness predicted improvements in disability. No moderators of depression were identified, but baseline values of self-efficacy, resilience, and hopelessness moderated disability. CONCLUSIONS CM-PST was as effective at reducing depression and disability among rural older adults as it was for urban older adults. Home-delivered CM-PST can be successfully adapted to meet the specific needs of rural seniors using resources often available in rural communities.
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Affiliation(s)
- Brooke Hollister
- University of California, San Francisco (BH, RC, SK, MB); Center for Caring Research, University of Agder, Norway (BH).
| | - Rebecca Crabb
- University of California, San Francisco (BH, RC, SK, MB)
| | - Sandi Kaplan
- University of California, San Francisco (BH, RC, SK, MB)
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Bitew T, Keynejad R, Myers B, Honikman S, Sorsdahl K, Hanlon C. Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia. Pilot Feasibility Stud 2022; 8:202. [PMID: 36085054 PMCID: PMC9461178 DOI: 10.1186/s40814-022-01166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia. METHODS We employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a 'theatre test', leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff. RESULTS In the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women's engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women's emotions to address PHC staff training needs, leading to the final version (version 4.0). CONCLUSION Using a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings.
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Affiliation(s)
- Tesera Bitew
- Department of Psychology, Injibara University, Institute of Educational and Behavioural Sciences, Injibara, Ethiopia.
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.
| | - Roxanne Keynejad
- Section of Women's Mental Health, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Bronwyn Myers
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simone Honikman
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Health Service and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Arean P, Hull D, Pullmann MD, Heagerty PJ. Protocol for a sequential, multiple assignment, randomised trial to test the effectiveness of message-based psychotherapy for depression compared with telepsychotherapy. BMJ Open 2021; 11:e046958. [PMID: 34728440 PMCID: PMC8565526 DOI: 10.1136/bmjopen-2020-046958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Digital mental health tools have become popular alternatives to traditional psychotherapy. One emerging form of digital mental health is message-based care, the use of text messages or asynchronous voice or video messaging to provide psychotherapy. There has been no research into whether this is an effective method of psychotherapy as a stand-alone treatment or in combination with traditional psychotherapy. METHODS AND ANALYSIS This is a sequential, multiple assignment randomised trial to compare message-based care, videoconference-psychotherapy and a combination of the two treatments in 1000 depressed adults. Participants will be recruited through Talkspace, a digital mental health company, and randomised to receive 6 weeks of either message-based care only or videoconference-psychotherapy only. At 6 weeks, participants will be evaluated for their response to treatment. Those with a 50% or more response to treatment will continue with their assigned condition. Those who do not respond will be randomised to either monthly videoconference-psychotherapy or weekly videoconference-psychotherapy plus message-based care. Primary outcomes will be depression and social functioning. We will also explore moderators of treatment outcome. ETHICS AND DISSEMINATION The study received ethics approval from the University of Washington Institutional Review Board. Results of this study will be presented in peer-reviewed journals and at professional conferences. TRIAL REGISTRATION NUMBER NCT04513080; Pre-results.
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Affiliation(s)
- Patricia Arean
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Derrick Hull
- Research and Development, Talkspace Network LLC, New York City, New York, USA
| | - Michael D Pullmann
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
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Marti CN, Kunik ME, Choi NG. The reciprocal relationship between depression and disability in low-income homebound older adults following tele-depression treatment. Int J Geriatr Psychiatry 2021; 36:802-810. [PMID: 33275787 PMCID: PMC8855885 DOI: 10.1002/gps.5480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/29/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Research has shown ample evidence for reciprocity between depression and disability. We examined whether decreases in disability among low-income, homebound older adults who received brief depression treatments were mediated by improvement in depressive symptoms and vice versa and whether the mediation effects varied by treatment modality. METHODS In a 3-arm randomized clinical trial, 277 low-income homebound individuals aged 50+ participated in behavioral activation tele-delivered by bachelor's-level lay counselors (Tele-BA), problem-solving therapy tele-delivered by licensed clinicians (Tele-PST), or telephone support calls (attention control). Depressive symptoms were assessed with the 24-item Hamilton Rating Scale for Depression and disability with the 12-item World Health Organization Disability Schedule 2.0. Along with mediation models, mediation was assessed controlling for autoregressive and contemporaneous effects. RESULTS Mediation models showed evidence of postintervention disability and depression mediating each other in separate mediation models. In the cross-lagged model, in which autoregressive and contemporaneous effects were included, only the depression-to-disability path exhibited mediation. There was no evidence of difference between Tele-BA and Tele-PST. Although the temporal precedence of treatment conditions on the outcomes is apparent, we could not establish a temporal precedence between disability and depression as these two measures exhibited parallel improvement. CONCLUSIONS Brief depression treatments for low-income homebound older adults were effective in reducing both depression and disability among these disabled older adults. The importance of this study lies in the comparable effects of Tele-BA and Tele-PST. Lay-counselor model is a promising alternative to clinician-delivered psychotherapy for growing numbers of homebound older adults.
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Affiliation(s)
- C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
| | - Mark E. Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA,Michael E. Debakey VA Medical Center, Houston, Texas, USA,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA,Baylor College of Medicine, Houston, Texas, USA
| | - Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
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Bitew T, Keynejad R, Myers B, Honikman S, Medhin G, Girma F, Howard L, Sorsdahl K, Hanlon C. Brief problem-solving therapy for antenatal depressive symptoms in primary care in rural Ethiopia: protocol for a randomised, controlled feasibility trial. Pilot Feasibility Stud 2021; 7:35. [PMID: 33514447 PMCID: PMC7846490 DOI: 10.1186/s40814-021-00773-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a high prevalence of antenatal depression in low- and middle-income countries, there is very little evidence for contextually adapted psychological interventions delivered in rural African settings. The aims of this study are (1) to examine the feasibility of procedures for a future fully powered efficacy trial of contextually adapted brief problem solving therapy (PST) for antenatal depression in rural Ethiopia, and (2) to investigate the acceptability, fidelity and feasibility of delivery of PST in routine antenatal care. METHODS Design: A randomised, controlled, feasibility trial and mixed method process evaluation. PARTICIPANTS Consecutive women attending antenatal clinics in two primary care facilities in rural Ethiopian districts. Eligibility criteria: (1) disabling levels of depressive symptoms (Patient Health Questionnaire (PHQ-9) score of five or more and positive for the 10th disability item); (2) gestational age 12-34 weeks; (3) aged 16 years and above; (4) planning to live in the study area for at least 6 months; (5) no severe medical or psychiatric conditions. INTERVENTION Four sessions of adapted PST delivered by trained and supervised antenatal care staff over a maximum period of eight weeks. CONTROL enhanced usual care (EUC). SAMPLE SIZE n = 50. Randomisation: individual randomisation stratified by intimate partner violence (IPV). Allocation: central phone allocation. Outcome assessors and statistician masked to allocation status. Primary feasibility trial outcome: dropout rate. Primary future efficacy trial outcome: change in PHQ-9 score, assessed 9 weeks after recruitment. SECONDARY OUTCOMES anxiety symptoms, trauma symptoms, intimate partner violence, disability, healthcare costs at 9 weeks; postnatal outcomes (perinatal and neonatal complications, onset of breast feeding, child health) assessed 4-6 weeks postnatal. Other trial feasibility indicators: recruitment, number and duration of sessions attended. Audio-recording of randomly selected sessions and in-depth interviews with purposively selected participants, healthcare providers and supervisors will be analysed thematically to explore the acceptability and feasibility of the trial procedures and fidelity of the delivery of PST. DISCUSSION The findings of the study will be used to inform the design of a fully powered efficacy trial of brief PST for antenatal depression in routine care in rural Ethiopia. TRIAL REGISTRATION The protocol was registered in the Pan-African clinical trials registry, (PACTR): registration number: PACTR202008712234907 on 18/08/2020; URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9578 .
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Affiliation(s)
- Tesera Bitew
- Department of Psychology, Institute of Educational and Behavioural Sciences, Debre Markos University, Debre Markos, Ethiopia.
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Roxanne Keynejad
- Institute of Psychiatry, Psychology & Neuroscience, Section of Women's Mental Health, King's College London, London, UK
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Simone Honikman
- Department of Psychiatry and Mental Health, Perinatal Mental Health Project, University of Cape Town, Cape Town, South Africa
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikirte Girma
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise Howard
- Institute of Psychiatry, Psychology & Neuroscience, Section of Women's Mental Health, King's College London, London, UK
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J. Fisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Identifying critical psychotherapy targets in serious cardiac conditions: The importance of addressing coping with symptoms, healthcare navigation, and social support. Palliat Support Care 2020; 17:531-535. [PMID: 30702055 DOI: 10.1017/s1478951518001037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In seriously ill cardiac patients, several psychotherapy efficacy studies demonstrate little to no reduction in depression or improvement in quality of life, and little is known about how to improve psychotherapies to best address the range of patient needs. An interpersonal and behavioral activation psychotherapy was a key component of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) multisite randomized clinical trial. Although depressive symptoms did improve in the CASA trial, questions remain about how best to tailor psychotherapies to the needs of seriously ill patient populations. The study objective was to describe psychosocial needs emerging during a clinical trial of a palliative care and interpersonal and behavioral activation psychotherapy intervention that were not specifically addressed by the psychotherapy. METHOD During the CASA trial, patient needs were prospectively tracked by the psychotherapist in each visit note using an a priori code list. Preplanned analysis of study data using directed content analysis was conducted analyzing the a priori code list, which were collapsed by team consensus into larger themes. The frequency of each code and theme were calculated into a percentage of visits. RESULT A total of 150 patients received one or more visits from the therapist and were included in the analysis. Participants screened positive for depressive disorder (47%), had poor heart failure-specific health status (mean Kansas City Cardiomyopathy Questionnaire score = 48.6; SD = 17.4), and multiple comorbidities (median 4.3). Common needs that emerged during the therapy included difficulty coping with fatigue (48%), pain (28%), and satisfaction issues with medical care (43%). The following broader themes emerged: social support (77% of sessions), unmet symptom needs (67%), healthcare navigation (48%), housing, legal, safety, and transportation (32%), and end of life (12%). SIGNIFICANCE OF RESULTS Coping with chronic symptoms and case management needs commonly emerged during psychotherapy visits. Future psychotherapy interventions in seriously ill populations should consider the importance of coping with chronic symptoms and case management.
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Raue PJ, Schulberg HC, Bruce ML, Banerjee S, Artis A, Espejo M, Catalan I, Romero S. Effectiveness of Shared Decision-Making for Elderly Depressed Minority Primary Care Patients. Am J Geriatr Psychiatry 2019; 27:883-893. [PMID: 30967321 PMCID: PMC6646064 DOI: 10.1016/j.jagp.2019.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The authors assessed the impact of a shared decision-making (SDM) intervention among elderly depressed minority primary care patients not currently receiving treatment. METHODS A total of 202 English and Spanish-speaking primary care participants aged 65 and older who scored positive on the Patient Health Questionnaire-9 (≥10) were randomized at the physician level to receive a brief SDM intervention or usual care (UC). Primary analyses focused on patient adherence to either psychotherapy or antidepressant medication, and reduction in depression severity (Hamilton Depression Rating Scale) over 12 weeks. RESULTS Patients randomized to physicians in the SDM condition were significantly more likely than patients of physicians randomized to UC to receive a mental health evaluation or initiate some form of treatment (39% versus 21%), and to adhere to psychotherapy visits over 12 weeks. There were no differences between groups in adherence to antidepressant medication or in reduction of depressive symptoms. CONCLUSION Among untreated elderly depressed minority patients from an inner-city municipal hospital, a brief SDM intervention was associated with greater initiation and adherence to psychotherapy. However, low treatment adherence rates across both groups and the intervention's lack of impact on clinical outcomes highlight the need to provide focused and accessible mental health services to patients choosing active treatments.
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Affiliation(s)
- Patrick J Raue
- Department of Psychiatry and Behavioral Sciences (PJR), University of Washington School of Medicine, Seattle.
| | - Herbert C Schulberg
- Weill Cornell Institute of Geriatric Psychiatry (HCS, SB), Weill Cornell Medical College, White Plains, NY
| | - Martha L Bruce
- Department of Psychiatry (MLB), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Samprit Banerjee
- Weill Cornell Institute of Geriatric Psychiatry (HCS, SB), Weill Cornell Medical College, White Plains, NY
| | - Amanda Artis
- Heart & Vascular Institute Cleveland Clinic, Cleveland (AA)
| | - Maria Espejo
- Lincoln Medical and Mental Health Center (ME), Bronx, NY
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Albert SM, King J, Anderson S, Dew MA, Zhang J, Stahl ST, Karp JF, Gildengers AG, Butters MA, Reynolds CF. Depression Agency-Based Collaborative: Effect of Problem-Solving Therapy on Risk of Common Mental Disorders in Older Adults With Home Care Needs. Am J Geriatr Psychiatry 2019; 27:619-624. [PMID: 30795944 PMCID: PMC6511292 DOI: 10.1016/j.jagp.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Interventions to prevent depression in older adults have mainly focused on young-old ambulatory adults, not on the old-old with disabilities who receive supportive services in their homes. OBJECTIVE The Depression Agency-Based Collaborative (Dep-ABC) is a single-blind pilot randomized controlled trial assessing the effect of an intervention-development strategy using problem-solving therapy (PST) on the risk of common mental health disorders in this vulnerable population. METHODS The intervention involved six to eight sessions of PST over 12 weeks. Participants were followed up to 12 months postintervention. RESULTS Dep-ABC randomized 104 participants-68.4% of eligible and 17.5% of all older adults screened. The proportion of participants with incident major depressive disorder or generalized anxiety disorder was 11.4% in PST and 14.3% in the enhanced usual care control arm. A test of the interaction between time and intervention for anxiety symptoms favored the PST arm (p = 0.04). CONCLUSION PST did not lower the risk of incident common mental illness but did lower anxiety symptom burden. Apart from low power, the effects of PST may have been blunted by referral for medical and aging services in the enhanced usual care group.
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Affiliation(s)
| | - Jennifer King
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | | | - Mary Amanda Dew
- Department of Biostatistics, University of Pittsburgh,Department of Psychiatry, University of Pittsburgh
| | - Jun Zhang
- Department of Biostatistics, University of Pittsburgh
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Millar RJ, Sahoo S, Yamashita T, Cummins P. Problem Solving in Technology-Rich Environments and Self-Rated Health Among Adults in the U.S.: An Analysis of the Program for the International Assessment of Adult Competencies. J Appl Gerontol 2019; 39:889-897. [PMID: 30762453 DOI: 10.1177/0733464819829663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Problem-solving skills in the context of technologically complex modern societies have become increasingly important to health management in later life. This study is designed to investigate the associations between problem-solving skills in technology-rich environments (PSTRE) and health, and to explore whether age differences exist. Using data from the 2012/2014 Program for the International Assessment of Adult Competencies (PIAAC), we used logistic regression to examine the relationship between PSTRE and self-reported health among a representative sample of American adults aged 35 years and older (N = 3,260). Overall, greater PSTRE (odds ratio [OR] = 1.012, p < .001) was significantly associated with better self-rated health even after adjusting for the sociodemographic characteristics. Yet, PSTRE was only partially predictive of health in some age groups. Our findings highlight the potential of PSTRE to reduce health disparities among middle-aged and older adults living in modern technology and information-rich societies.
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Stanley MA, Wilson NL, Shrestha S, Amspoker AB, Wagener P, Bavineau J, Turner M, Fletcher TL, Freshour J, Kraus-Schuman C, Kunik ME. Community-Based Outreach and Treatment for Underserved Older Adults With Clinically Significant Worry: A Randomized Controlled Trial. Am J Geriatr Psychiatry 2018; 26:1147-1162. [PMID: 30224269 DOI: 10.1016/j.jagp.2018.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/05/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether Calmer Life (CL) improved worry, generalized anxiety disorder-related (GAD-related) symptoms, anxiety, depression, sleep, trauma-related symptoms, functional status, and quality of life better than Enhanced Community Care with Resource Counseling (ECC-RC) at 6 months and 9 months. METHODS A randomized, controlled, comparative-effectiveness study involving underserved, low-income, mostly minority neighborhoods in Houston, Texas, looked at individuals ≥50 with significant worry and interest in psychosocial treatment. Interventions were CL, cognitive behavioral therapy with resource counseling, facilitation of communication with primary care providers about worry/anxiety, integration of religion/spirituality, person-centered skill content and delivery and nontraditional community providers, ECC-RC, and enhanced standard community-based information/ resource counseling addressing basic unmet and mental health needs. Primary outcomes were worry and GAD-related symptom severity. Secondary outcomes were anxiety, depression, sleep difficulties, trauma-related symptoms, functional status, quality of life, service use and satisfaction. RESULTS Similar, moderate improvements followed CL and ECC-RC on worry, GAD-related symptoms, anxiety, depression, sleep, trauma-related symptoms, and mental health quality of life at 6 and 9 months, but with symptoms at both times and higher satisfaction with CL at both. Fewer ECC-RC participants reported a hospital admission in the prior 3 months than those in CL at 6 and 9 months; at 9 months, fewer reported a visit with a provider in the previous 3 months. CONCLUSION Both interventions showed similar improvements at 6 and 9 months, but symptoms remained that might require care. Either intervention or a combination may be useful for low-income older adults with identified worry/anxiety.
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Affiliation(s)
- Melinda A Stanley
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston.
| | - Nancy L Wilson
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Srijana Shrestha
- St. Thomas University (SS), Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Amber B Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Paula Wagener
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | | | | | - Terri L Fletcher
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston
| | - Jessica Freshour
- Michael E. DeBakey VA Medical Center (JF, CKS), Houston, TX; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Cynthia Kraus-Schuman
- Michael E. DeBakey VA Medical Center (JF, CKS), Houston, TX; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston
| | - Mark E Kunik
- HSR&D Center for Innovations in Quality, Effectiveness and Safety (MAS, NLW, ABA, PW, TLF, MEK), Michael E. DeBakey VA Medical Center, Houston; Baylor College of Medicine (MAS, NLW, SS, ABA, PW, TLF, JF, CKS, MEK), Houston; the VA South Central Mental Illness Research, Education and Clinical Center (MAS, TLF, MEK), Houston
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12
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Chang KJ, Hong CH, Roh HW, Lee KS, Lee EH, Kim J, Lim HK, Son SJ. A 12-Week Multi-Domain Lifestyle Modification to Reduce Depressive Symptoms in Older Adults: A Preliminary Report. Psychiatry Investig 2018; 15:279-284. [PMID: 29475242 PMCID: PMC5900365 DOI: 10.30773/pi.2017.08.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the effectiveness of usual care management (UCM) and a newly-developed lifestyle modification with contingency management (LMCM) for geriatric depressive symptoms in the community. METHODS A randomized controlled trial was conducted in 93 older adults with major depressive disorder at community mental health centers. A 12 week multi-domain LMCM was developed by providing positive reinforcement using 'gold medal stickers' as a symbolic incentive to motivate their participation and adherence. Participants were allocated to LMCM (n=47) and UCM (n=46) groups. They were then subjected to the 12 week treatment. Effects of the two intervention methods on Geriatric Depression Scale were determined using mixed model analysis. RESULTS Participants in the LMCM group had greater decline in GDS score per month than participants in the UCM group after adjusting for age, sex, years of education, living alone, and MMSE scores at baseline examination [coefficient for GDS score (95% CI): -1.08 (-1.51, -0.65), p<0.001, reference: UCM group]. CONCLUSION LMCM is safe and easy to use with a low cost. LMCM is suitable as psychosocial intervention for older adults with depressive symptoms in the community.
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Affiliation(s)
- Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kang Soo Lee
- Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Seongnam, Republic of Korea
| | - Eun Hee Lee
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jinju Kim
- Department of Psychiatry, Ajou Danam Hospital, Suwon, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
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Abstract
PURPOSE OF REVIEW We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings. RECENT FINDINGS Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.
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14
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Anguera JA, Gunning FM, Areán PA. Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial. Depress Anxiety 2017; 34:508-517. [PMID: 28052513 PMCID: PMC6093618 DOI: 10.1002/da.22588] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/14/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol. METHODS In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard. RESULTS EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence. CONCLUSIONS This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings.
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Affiliation(s)
- Joaquin A. Anguera
- Department of Neurology, University of California, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Faith M. Gunning
- Department of Psychiatry, Weil Cornell Medicine, New York, NY, USA
| | - Patricia A. Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington
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15
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Renn BN, Areán PA. Psychosocial Treatment Options for Major Depressive Disorder in Older Adults. ACTA ACUST UNITED AC 2017; 4:1-12. [PMID: 28932652 DOI: 10.1007/s40501-017-0100-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Late-life depression (LLD) is a public health concern with deleterious effects on overall health, cognition, quality of life, and mortality. Although LLD is relatively common, it is not a normal part of aging and is often under-recognized in older adults. However, psychotherapy is an effective treatment for LLD that aligns with many patients' preferences and can improve health and functioning. This review synthesized the current literature on evidence-based psychotherapies for the treatment of depression in older adults. Findings suggest that active, skills-based psychotherapies (cognitive behavioral therapy [CBT] and problem-solving therapy [PST]) may be more effective for LLD than non-directive, supportive counseling. PST may be particularly relevant for offsetting skill deficit associated with LLD, such as in instances of cognitive impairment (especially executive dysfunction) and disability. Emerging treatments also consider contextual factors to improve treatment delivery, such as personalized care, access, and poverty. Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults. Although these strategies hold promise, further investigation via randomized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD. Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence-based psychosocial interventions for LLD.
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Affiliation(s)
- Brenna N Renn
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Patricia A Areán
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
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