Please select the eligibility criteria that correspond to the clinical trial below.
Title: Shared Decision-Making for Elderly Depressed Primary Care Patients
Brief Summary: Shared decision-making (SDM), in contrast to traditional medical decision-making, involves a collaborative process where patients discuss personal values and preferences and clinicians provide information to arrive at an agreed upon treatment decision. The proposed study will evaluate the impact of a brief SDM nursing intervention among elderly, depressed primary care patient subjects in comparison to physician recommended Usual Care. The focus of the SDM intervention is to empower depressed patients and help them arrive at a treatment decision that can be successfully carried out.


Options:
A: Inclusion Criteria:

* 18 or older
* pregnant: 12-32 weeks gestation
* able to speak English
* telephone access
* major depressive disorder or dysthymia
* on Medicaid
* receiving health care in King County, Washington

Exclusion Criteria:

* currently in psychotherapy
* currently receiving pharmacotherapy from a psychiatrist
* high suicide risk
* history of bipolar disorder
* history of schizophrenia
* substance use or dependence in previous 3 months
* currently in a relationship with severe interpersonal violence
* history of repetitive self-harm behavior
B: Inclusion Criteria:

* Age: 65 years and older;
* Medical outpatient presenting to Lincoln Hospital, Bronx NY, the New York City Health and Hospitals Corporation (HHC);
* Screen positive (PHQ-9 score\>9 for depression, in addition to primary care physician recommendation for depression treatment.

Exclusion Criteria:

* Presence of significant alcohol or substance abuse, psychotic disorder, or bipolar disorder;
* High suicide risk, i.e. intent or plan to attempt suicide in near future;
* Current treatment with antidepressant medication or psychotherapy prior to index physician visit (with the exception of low doses of antidepressant medication for pain disorders);
* Cognitive impairment: MMSE score \<20 or clinical diagnosis of dementia;
* Acute or severe medical illness, i.e., delirium, metastatic cancer, decompensated cardiac, liver, or kidney failure, major surgery, stroke or myocardial infarction during the three months prior to entry; or drugs often causing depression, e.g., steroids, reserpine, alpha-methyl-dopa, tamoxifen, vincristine;
* Aphasia interfering with communication.
C: Inclusion Criteria:

* diagnosis of dementia based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV
* from moderate to severe cognitive decline (Global Deterioration Scale from 4 to 6)
* supported by a family caregiver who can be involved

Exclusion Criteria:

* unable to pronounce simple sentences
D: Inclusion Criteria:

* currently receive services in the VASDHS PRRC

  * i.e., seen in the clinic in the past month and/or completed a PRRC group during the past trimester
* have an SMI diagnosis per the electronic medical record

  * e.g., schizophrenia, schizoaffective disorder, delusional disorder, and major depressive disorder with psychotic features
* agree to have a subset of treatment appointments audiotaped

Exclusion Criteria:

* having primary substance use or organic neurological disorder diagnosis
* are determined by PRRC and/or study staff to be at significant risk of exacerbation of symptoms, suicidal ideation, or other risk due to study participation
* have a history and/or current risk of violence that PRRC and/or study staff determine to be too high risk to manage effectively at the PRRC's outpatient clinic location (which has less police presence than the primary VASDHS hospital location)

Answer: B