Improving Depression Treatment for Older Minority Adults

Study Overview
=================
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

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.

Official Title
-----------------
Improving Depression Treatment for Older Minority Adults

Conditions
-----------------
Depression

Intervention / Treatment
-----------------
* Behavioral: Problem Solving Therapy (PST)
* Behavioral: Medication Management


Participation Criteria
=================
Eligibility Criteria
-----------------
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

Ages Eligible for Study
-----------------
Minimum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1.<br>All participants | Behavioral: Problem Solving Therapy (PST)<br>* Counseling<br>Behavioral: Medication Management<br>* 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.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depression severity, depression treatment preferences, and barriers to care |  | baseline and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility, acceptability, and effectiveness of intervention |  | 6 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
psychotherapy, behavior therapy, counseling, aging, medically underserved population