Improving Depression Treatment for Older Minority Adults
概览
- 阶段
- 不适用
- 干预措施
- 未指定
- 疾病 / 适应症
- Depression
- 发起方
- National Institute on Aging (NIA)
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Depression severity, depression treatment preferences, and barriers to care
- 状态
- 已完成
- 最后更新
- 17年前
概览
简要总结
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
详细描述
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.
研究者
入排标准
入选标准
- •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
排除标准
- •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
结局指标
主要结局
Depression severity, depression treatment preferences, and barriers to care
时间窗: baseline and 6 months
次要结局
- Feasibility, acceptability, and effectiveness of intervention(6 months)