Effectiveness of Case Management Versus Case Management Plus Problem-solving Therapy to Treat Depression in Low-income Elders
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This study will compare the effectiveness of case management combined with problem-solving
      therapy (CM-PST) versus case management (CM) alone for assisting elderly people with
      depression.
    

Detailed description: 
      Depression is a common mental disorder that affects many low-income elders. Many elders
      suffer from multiple chronic illnesses and often must deal with social and financial
      hardships as they continue to age. Rates of diagnosis and treatment for depression within the
      elderly population are low. This may be because elders are embarrassed to discuss their
      symptoms with their doctor and assume sadness and anxiety are a normal part of the aging
      process. However, depression is not a normal consequence of aging. Furthermore, it can
      severely impact people's lives, sleep patterns, concentration, and energy levels. This study
      will compare the effectiveness of case management combined with problem-solving therapy
      (CM-PST) versus case management (CM) alone for assisting elderly people diagnosed with
      depression.

      CM involves identifying a person's particular needs and working with a case worker to plan
      and implement specific resources and services that will meet those needs. PST emphasizes the
      social context of an individual's situation through problem-solving and behavior change
      techniques. Recent studies have suggested that combining CM with PST may have a mutually
      beneficial effect on depressed, low-income elders. CM can help elders with their social and
      financial needs, and PST can improve their ability to cope with stressful events and utilize
      their new resources.

      Participants in this open-label study will be randomly assigned to receive 12 sessions of
      either CM or CM-PST. Both treatments will be delivered at the participant's home by a trained
      case worker. Participants assigned to receive CM will focus on increasing their resources and
      reducing adversity. The case worker will help participants determine the causes of their
      unmet needs, create an action plan to meet those needs, encourage the use of services, and
      possibly advise their family members and health care providers to help facilitate the use of
      those services. Participants assigned to CM-PST will undergo a needs assessment during the
      first session to develop a problem-solving plan that will be implemented over the next 11
      sessions. Each session will include instruction on how to use the PST approach to solve
      problems identified by both the therapist and participant. All participants will undergo a
      neuropsychological exam and complete psychological and physical functioning questionnaires
      prior to treatment and at Weeks 3, 6, 12, and 24.
    

Intervention name(s): Problem-solving therapy (PST); Case management (CM)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The premise of PST is that psychotherapies implicitly help people to become better managers of their lives, in effect, to become better at solving problems. Unlike Case Management (CM) that seeks to increase its clients' availability and utilization of resources, PST focuses on the patients themselves and helps them develop skills in identifying, prioritizing, and solving problems, and thereby creates a sense of empowerment. Although CM and PST have different theoretical premises, they both focus on the resolution of concrete problems promoting depression.; Different types of CM exist, but all share the theme of helping individuals cope with their illnesses through linkage to social services, advocacy, rehabilitation, and ongoing support during recovery from illnesses. CM will consist of the following components: 1) socialization to treatment; 2) needs assessment; 3) psychoeducation about depression; 4) service planning; 5) linkage to social services; 6) help with access to health care; 7) advocacy; and 8) exploration of barriers that perpetuate unmet needs.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Homebound Persons; Case Management; Problem Solving Therapy