Improving Depression Treatment for Older Minority Adults

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00570427
Recruitment Status : Completed
First Posted : December 11, 2007
Last Update Posted : February 25, 2009
University of California, Los Angeles
Information provided by:
National Institute on Aging (NIA)

Brief Summary:
The purpose of this study is to improve access to quality depression care for older, low-income, minority adults in public sector health care. The study will examine current depression care in a public sector geriatric clinic that serves mostly Spanish-speaking Latinos and pilot study assessments and treatments in order to lay the groundwork for a large study of quality improvement for depressed older minorities

Condition or disease Intervention/treatment Phase
Depression Behavioral: Problem Solving Therapy (PST) Behavioral: Medication Management Not Applicable

Detailed Description:

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.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Improving Depression Treatment for Older Minority Adults
Study Start Date : February 2007
Actual Primary Completion Date : June 2008
Actual Study Completion Date : June 2008

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Experimental: 1.
All participants
Behavioral: Problem Solving Therapy (PST)
Behavioral: 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.

Primary Outcome Measures :
  1. Depression severity, depression treatment preferences, and barriers to care [ Time Frame: baseline and 6 months ]

Secondary Outcome Measures :
  1. Feasibility, acceptability, and effectiveness of intervention [ Time Frame: 6 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   60 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients of the LAC+USC Medical Center Geriatric Clinic
  • English- or Spanish-speaking
  • Positive for depression on the Geriatric Depression Scale
  • Current major depressive disorder or dysthymia
  • All adult family members, especially caregivers, and all regular clinic providers eligible for interviews

Exclusion Criteria:

  • History of bipolar disorder or psychosis
  • Significant cognitive impairment (score less than 24 on the Mini-Mental Status Examination, adjusted for age and education)
  • Acute suicidal ideation

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00570427

United States, California
LAC+USC Medical Center Geriatric Clinic
Los Angeles, California, United States, 90033
Sponsors and Collaborators
National Institute on Aging (NIA)
University of California, Los Angeles
Principal Investigator: Isabel T. Lagomasino, MD MSHS Department of Psychiatry, Keck School of Medicine, University of Southern California

Responsible Party: Isabel T. Lagomasino, MD MSHS, Keck School of Medicine, University of Southern California Identifier: NCT00570427     History of Changes
Other Study ID Numbers: AG0091
5P30AG021684 ( U.S. NIH Grant/Contract )
1557 G GD102
First Posted: December 11, 2007    Key Record Dates
Last Update Posted: February 25, 2009
Last Verified: February 2009

Keywords provided by National Institute on Aging (NIA):
behavior therapy
medically underserved population

Additional relevant MeSH terms:
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders