Clinical trial NCT00570427: Improving Depression Treatment for Older Minority Adults
Official title: Improving Depression Treatment for Older Minority Adults
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Depression
Keywords: psychotherapy
behavior therapy
counseling
aging
medically underserved population
Lead sponsor: National Institute on Aging (NIA)
Sponsor class: NIH
Collaborators: name: University of California, Los Angeles
First posted: 2007-12-11
Enrollment: 30
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

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.

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

Primary outcomes:
measure: Depression severity, depression treatment preferences, and barriers to care
timeFrame: baseline and 6 months
Secondary outcomes:
measure: Feasibility, acceptability, and effectiveness of intervention
timeFrame: 6 months
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: LAC+USC Medical Center Geriatric Clinic
state: California
Study officials:
affiliation: Department of Psychiatry, Keck School of Medicine, University of Southern California
name: Isabel T. Lagomasino, MD MSHS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Dwight-Johnson M, Lagomasino IT. Addressing depression treatment preferences of ethnic minority patients. Gen Hosp Psychiatry. 2007 May-Jun;29(3):179-81. doi: 10.1016/j.genhosppsych.2007.02.001. No abstract available.
citation: Vega WA, Karno M, Alegria M, Alvidrez J, Bernal G, Escamilla M, Escobar J, Guarnaccia P, Jenkins J, Kopelowicz A, Lagomasino IT, Lewis-Fernandez R, Marin H, Lopez S, Loue S. Research issues for improving treatment of U.S. Hispanics with persistent mental disorders. Psychiatr Serv. 2007 Mar;58(3):385-94. doi: 10.1176/ps.2007.58.3.385.
citation: Lagomasino IT, Dwight-Johnson M, Miranda J, Zhang L, Liao D, Duan N, Wells KB. Disparities in depression treatment for Latinos and site of care. Psychiatr Serv. 2005 Dec;56(12):1517-23. doi: 10.1176/appi.ps.56.12.1517.