Improving Depression Treatment for Older Minority Adults
|Depression||Behavioral: Problem Solving Therapy (PST) Behavioral: Medication Management|
|Study Design:||Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Improving Depression Treatment for Older Minority Adults|
- Depression severity, depression treatment preferences, and barriers to care [ Time Frame: baseline and 6 months ]
- Feasibility, acceptability, and effectiveness of intervention [ Time Frame: 6 months ]
|Study Start Date:||February 2007|
|Study Completion Date:||June 2008|
|Primary Completion Date:||June 2008 (Final data collection date for primary outcome measure)|
Behavioral: Problem Solving Therapy (PST)
CounselingBehavioral: Medication Management
If a participant chooses to receive antidepressant medication while in the study, a depression care specialist works with the participant's usual primary care provider to initiate an appropriate prescription and to follow-up with side effects, adherence, efficacy, etc. on a monthly or biweekly basis.
Depressive disorders affect 5-10% of older primary care patients, although rates may be higher among Latinos, especially among immigrants and those less acculturated. Late-life depression may be chronic and recurrent and results in significant morbidity and mortality. Despite a growing evidence base for the treatment of geriatric depression, only half of depressed older adults receive mental health care; fewer than 10% receive specialty services. Treatment rates are even lower for low-income, ethnic minorities who may be more ill and disabled, may lack adequate insurance and have different treatment preferences, and who frequently face barriers to accessing care. Recent quality improvement interventions for geriatric depression have targeted primary care, the location where older patients and ethnic minorities are most likely to receive mental health services. A recent multi-site, randomized trial of collaborative care for geriatric depression in primary care offered patients their choice of treatments, including antidepressant medication or 6-8 sessions of a structured psychotherapy. Although the intervention had few cultural accommodations, both processes and outcomes of care improved for depressed older minorities. However, because the study only included Latinos who were English-speaking and mostly high school graduates, these results may not generalize to a large proportion of ethnic minorities.
This study first examines current rates of depression and patterns of depression treatment in a public-sector geriatric clinic that serves mostly Spanish-speaking Latinos. Then depressed patients are identified and their depression treatment preferences and barriers to care are assessed. Patients are enrolled in a 6-month patient-centered, evidence-based intervention, and they, family members, and clinic medical providers are interviewed at program end to assess the feasibility, acceptability, and possible effectiveness of the intervention.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00570427
|United States, California|
|LAC+USC Medical Center Geriatric Clinic|
|Los Angeles, California, United States, 90033|
|Principal Investigator:||Isabel T. Lagomasino, MD MSHS||Department of Psychiatry, Keck School of Medicine, University of Southern California|