EM/PROTECT: Improving Depression in Elder Mistreatment Victims
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The investigators developed EM/PROTECT, a behavioral intervention for depressed EM (elderly
      mistreatment) victims, to work in synergy with EM mistreatment resolution services that
      provide safety planning, support services, and links to legal services. PROTECT is built on a
      model which postulates that chronic stress promotes dysfunction of the cognitive control
      (CCN) and reward networks, impairing the victims' ability to flexibly respond to the
      environment and limits their reward activities. PROTECT therapists work with victims to
      develop action plans to reduce stress, and to increase rewarding experiences. EM/PROTECT has
      been designed in an iterative process with community EM providers of the New York City (NYC)
      Department for the Aging (DFTA) to use agencies' routine PHQ-9 depression screening and
      referral for service. In the current study, the investigators will compare the effectiveness
      of EM/PROTECT with EM enriched with staff training in linking EM victims to community mental
      health services (EM/MH). The investigators intend to enroll 80 subjects that will participate
      in the study for approximately 12 weeks.
    

Detailed description: 
      One in ten older adults is a victim of mistreatment, and one third of victims have clinically
      significant depressive symptoms. Depression increases mortality and decreases motivation to
      take self-protective steps. Yet, no elder mistreatment (EM) agencies have embedded
      identification and treatment of depressed EM victims in their programs. The investigators
      developed EM/PROTECT, a behavioral intervention for depressed EM victims, to work in synergy
      with EM agencies that provide safety planning and links to legal services. EM/PROTECT has
      been designed in an iterative process with community EM providers of the NYC Department for
      the Aging (DFTA), to utilize agencies' routine depression screening and service referrals.
      The investigators propose to collect data on the feasibility and acceptability of EM/PROTECT
      as one of three developmental projects under the ALACRITY Center NIMH grant (1 P50
      MH113838-01,PI: Alexopoulos) (IRB 1704018108). We will compare the effectiveness of
      EM/PROTECT with EM enriched with staff training in linking EM victims to community mental
      health services (EM/MH). To ensure rigor and reproducibility, EM/PROTECT or EM/MH will be
      offered to randomly assigned depressed EM victims. All EM victims will receive standard EM
      resolution services from DFTA. EM staff will screen and refer depressed victims to Cornell
      staff, who will describe the study and obtain consent. Standardized assessments will be
      conducted by trained raters blind to participant assignment.

      In addition, the investigators will use both active and passive sensing technology through
      smartphone data collection to supplement in-person data collection with an objective measure
      of socialization and behavioral activation. Smartphone data will be used to explore whether
      adherence to active recordings and time spent carrying the phone is associated with greater
      effectiveness of EM/PROTECT.
    

Intervention name(s): EM/PROTECT; EM/MH
Intervention type(s): Behavioral; Behavioral
Intervention description(s): EM/PROTECT is a behavioral intervention for depressed elder mistreatment (EM) victims designed to work in synergy with EM mistreatment resolution services that provide safety planning, support services, and links to legal services; EM/MH provides individuals experiencing elder mistreatment with support services from staff trained in linking elder mistreatment victims to community mental health services.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The investigators will compare the effectiveness and target engagement of EM/PROTECT with EM enriched with training of EM staff in linking EM victims to mental health services (EM/MH) in order to position us for a fully powered R01. To ensure rigor and reproducibility, EM/PROTECT or EM/MH will be offered to randomly assigned depressed EM victims, and standard assessments will be conducted by trained raters blind to participant assignment and our hypotheses.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Elder abuse; Depression; Mental health