Calmer Life: Treating Worry Among Older Adults In Underserved, Low-income, Minority Communities

Study Overview
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Brief Summary
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The purpose of this research study is to see how helpful two different interventions offered through the Calmer Life program are in reducing worry and improving mood. The investigators also want to understand how a program like Calmer Life can be offered in underserved communities.

Detailed Description
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Background: Recurrent, excessive, uncontrollable worry about multiple topics is common in older adults, but it is not well studied. This significant worry can negatively affect thinking, and it is associated with poorer sleep, more depression, and worse general health. Despite its prevalence, researchers have not studied significant worry enough, particularly in low-income racial and ethnic minority populations. We know these groups are unlikely to have adequate mental health care. We also know that older adults and minorities prefer treatments for worry that do not require medication, and that these kinds of treatments can be effective. Additional tests of treatments that do not involve drugs are needed in low-income racial and ethnic minority populations. Such person-centered research could expand access to appropriate care. Objectives: The study team plans to compare two approaches, one called Calmer Life (CL) and another called Enhanced Community Care (ECC). CL helps individuals by providing worry-reduction skills and resource counseling for basic needs in a flexible, culturally supportive manner. ECC relies on standard information and resource counseling. The study will answer three questions. First, compared to ECC, is CL more effective at relieving significant worry? Second, which one is more effective at reducing anxiety and depression and improving sleep, ability to do daily activities, and use of medical services? Third, are improvements still present three months after treatment concludes? Methods: In agreement with our community partners and governed by a council of community leaders, consumers, and providers from low-income minority communities, we will conduct the study. This community-academic partnership, created four years ago, introduced CL to the community. Case managers and community health workers from partner organizations were trained to implement CL. They taught worry-reduction skills and helped participants increase their use of community resources. Content was flexible so that participants could choose which skills to learn and whether or not to include religion or spirituality. They also could learn skills at home, by telephone, or in the community. In a new, larger comparison study, we will enroll 120 women and 30 men who are 50 years of age or older with significant worry. Most (80 percent) will be African American, and 70 percent will have income below poverty. Participants will be assigned by chance to CL or ECC and treated for six months. Brief assessments at enrollment and at six and nine months will rely on participants' reports. Differences will be measured statistically.

Official Title
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Calmer Life: Treating Worry Among Older Adults In Underserved, Low-income, Minority Communities

Conditions
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Anxiety

Intervention / Treatment
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* Behavioral: Cognitive behavior treatment
* Behavioral: Information and referral


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: PSWQ greater than 22 Exclusion Criteria: PHQ score less than 20 Active suicidal intent Active psychosis or bipolar disorder Substance abuse Cognitive impairment

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Calmer Life<br>Cognitive behavior treatment for anxiety | Behavioral: Cognitive behavior treatment<br>* Anxiety management skills with the option to included religious/spiritual beliefs and practices<br>|
| Active Comparator: Enhanced Community Care<br>Enhanced information and referral services for mental health and basic needs | Behavioral: Information and referral<br>* Resource counseling and follow-up for mental health and basic needs<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Penn State Worry Questionnaire - A (PSWQ-A) at 6 Months | Brief measure of worry with 8 items measured on a 1-5 scale (1 = not at all typical, 3 = somewhat typical, 5 = very typical). Scores range from 8 to 40. Higher scores indicate greater anxiety. | Baseline, 6 months | 
| Penn State Worry Questionnaire - A (PSWQ-A) at 9 Months | Brief measure of worry with 8 items measured on a 1-5 scale (1 = not at all typical, 3 = somewhat typical, 5 = very typical). Scores range from 8 to 40. Higher scores indicate greater anxiety. | Baseline, 9 months | 
| Generalized Anxiety Disorder-7 (GAD-7) at 6 Months | Measure of Generalized Anxiety Disorder symptoms. 7 items rated from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 21. Higher scores indicate greater GAD symptoms. | Baseline, 6 months | 
| Generalized Anxiety Disorder-7 (GAD-7) at 9 Months | Measure of Generalized Anxiety Disorder symptoms. 7 items rated from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 21. Higher scores indicate greater GAD symptoms. | Baseline, 9 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Geriatric Anxiety Inventory - SF (GAI-SF) at 6 Months | Five item scale with response options of yes = 1 and no = 0 to each item. Scores range from 0 to 5. Greater scores indicate greater anxiety. | Baseline, 6 months | 
| Geriatric Anxiety Inventory - SF (GAI-SF) at 9 Months | Five item scale with response options of yes = 1 and no = 0 to each item. Scores range from 0 to 5. Greater scores indicate greater anxiety. | Baseline, 9 months | 
| Patient Health Questionnaire Depression Scale (PHQ 8) at 6 Months | Brief measure of depression symptoms consisting of 8 items rated from 0-3 (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day). Scores range from 0 to 24. Higher scores indicate greater depression severity. | Baseline, 6 months | 
| Patient Health Questionnaire Depression Scale (PHQ 8) at 9 Months | Brief measure of depression symptoms consisting of 8 items rated from 0-3 (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day). Scores range from 0 to 24. Higher scores indicate greater depression severity. | Baseline, 9 months | 
| Geriatric Depression Scale Short Form (GDS) at 6 Months | Brief measure of depression designed for use with older adults consisting of 15 items rated yes (1) or no (0). Scores range from 0 to 15. Higher scores indicate greater depression. | Baseline, 6 months | 
| Geriatric Depression Scale Short Form (GDS) at 9 Months | Brief measure of depression designed for use with older adults consisting of 15 items rated yes (1) or no (0). Scores range from 0 to 15. Higher scores indicate greater depression. | Baseline, 9 months | 
| Insomnia Severity Index (ISI) at 6 Months | Measure of sleep difficulties consisting of 7 items rated on a 0-4 scale. Scores range from 0 to 28. Higher scores indicate greater sleep difficulties. | Baseline, 6 months | 
| Insomnia Severity Index (ISI) at 9 Months | Measure of sleep difficulties consisting of 7 items rated on a 0-4 scale. Scores range from 0 to 28. Higher scores indicate greater sleep difficulties. | Baseline, 9 months | 
| Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Frequency at 6 Months | Measure that assesses disability frequency across 16 life tasks and social roles. Frequencies for the 16 items are rated on a scale from 1 (never) to 5 (very often). Summary scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher participation in tasks/higher functioning. | Baseline, 6 months | 
| Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Frequency at 9 Months | Measure that assesses disability frequency across 16 life tasks and social roles. Frequencies for the 16 items are rated on a scale from 1 (never) to 5 (very often). Summary scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher participation in tasks/higher functioning. | Baseline, 9 months | 
| Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Limitation at 6 Months | Measure that assesses disability limitations across 16 life tasks and social roles. Limitations for the 16 items are rated on a scale from 1 (completely limited) to 5 (not at all limited). Raw scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher levels of capability of participating in tasks/higher functioning. | Baseline, 6 months | 
| Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Limitation | Measure that assesses disability limitations across 16 life tasks and social roles. Limitations for the 16 items are rated on a scale from 1 (completely limited) to 5 (not at all limited). Raw scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher levels of capability of participating in tasks/higher functioning. | Baseline, 9 months | 
| Medical Outcomes Study 12-Item Short-Form Health Survey Physical Component Summary (SF-12 PCS) at 6 Months | Physical component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100. Higher scores indicate higher levels of physical functioning. | Baseline, 6 months | 
| Medical Outcomes Study 12-Item Short-Form Health Survey Physical Component Summary (SF-12 PCS) | Physical component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100. Higher scores indicate higher levels of physical functioning. | Baseline, 9 months | 
| Medical Outcomes Study 12-Item Short-Form Survey Mental Component Summary (SF-12 MCS) at 6 Months | Mental component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100.Higher scores indicate higher levels of mental health functioning. | Baseline, 6 months | 
| Medical Outcomes Study 12-Item Short-Form Survey Mental Component Summary (SF-12 MCS) at 9 Months | Mental component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100.Higher scores indicate higher levels of mental health functioning. | Baseline, 9 months | 
| PTSD Checklist-5 (PCL-5) Total at 6 Months | Measure of PTSD symptoms. 20 items rated from 0 (not at all) to 4 (extremely). Scores range from 0 to 80. Higher scores = higher symptom severity. | Baseline, 6 months | 
| PTSD Checklist-5 (PCL-5) Total at 9 Months | Measure of PTSD symptoms. 20 items rated from 0 (not at all) to 4 (extremely). Scores range from 0 to 80. Higher scores = higher symptom severity. | Baseline, 9 months | 
| Health Service Use at 6 Months | Number of participants who had visited a health care provider (e.g., physician, nurse, physician's assistant) over the past 3 months. | Baseline, 6 months | 
| Health Service Use at 9 Months | Number of participants who had visited a health care provider (e.g., physician, nurse, physician's assistant) over the past 3 months. | Baseline, 9 months | 
| Hospital Admissions at 6 Months | Number of participants who were admitted to a hospital in the past 3 months. | Baseline, 6 months | 
| Hospital Admissions at 9 Months | Number of participants who were admitted to a hospital in the past 3 months. | Baseline, 9 months | 
| Social Service or Resource Use at 6 Months | Number of participants who received social services or resources over the past 3 months | Baseline, 6 months | 
| Social Service or Resource Use at 9 Months | Number of participants who received social services or resources over the past 3 months | Baseline, 9 months | 
| Psychological Service Use at 6 Months | Number of participants who discussed personal or emotional problems with a medical provider, clergy, mental health provider, or support group over the past 3 months | Baseline, 6 months | 
| Psychological Service Use at 9 Months | Number of participants who discussed personal or emotional problems with a medical provider, clergy, mental health provider, or support group over the past 3 months | Baseline, 9 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anxiety, worry