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Can a Home-Based Intervention Reduce Depression in Older African Americans? FREE

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The full report is titled “A Home-Based Intervention to Reduce Depressive Symptoms and Improve Quality of Life in Older African Americans. A Randomized Trial.” It is in the 20 August 2013 issue of Annals of Internal Medicine (volume 159, pages 243-252). The authors are L.N. Gitlin, L. Fields Harris, M.C. McCoy, N.L. Chernett, L.T. Pizzi, E. Jutkowitz, E. Hess, and W.W. Hauck.

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Ann Intern Med. 2013;159(4):I-16. doi:10.7326/0003-4819-159-4-201308200-00001
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What is the problem and what is known about it so far?

Depression is common among older adults. If not successfully treated, even mild to moderate depression can increase the risk for dementia, contribute to poor health outcomes, and reduce quality of life. Symptoms of depression are often underrecognized and undertreated in primary care, particularly for older African Americans. Older adults may not be comfortable seeking treatment from their physicians, but involving a trusted community-based agency may help to reduce this barrier to care. Although home-based nonpharmacologic depression treatment is promising, testing among older African Americans has been limited.

Why did the researchers do this particular study?

To find out whether the home-based Beat the Blues (BTB) intervention alleviated depressive symptoms and improved quality of life in older African Americans.

Who was studied?

208 African Americans older than 55 years (average age, 70 years) with depression. They were considered depressed if they scored 5 or higher on the Patient Health Questionnaire-9 (PHQ-9), a 9-item depression scale, at 2 testing occasions 2 weeks apart. Individuals were excluded if they had a history of serious mental illness, life-limiting illness, or involvement in another depression trial.

How was the study done?

The researchers partnered with a senior center in the Philadelphia, Pennsylvania, area. Between May 2008 and November 2010, they enrolled participants through outreach to the community and to temporarily homebound elderly adults in an assistance program administered by the senior center.

Participants were assigned to either the BTB intervention group or a wait-list control group. The BTB intervention included up to ten 1-hour in-home sessions with a social worker over 4 months. The sessions addressed unmet care needs, referral to social and medical services, depression education, stress reduction techniques, and identification of personal activity goals (such as managing chronic conditions, socialization, exercise, traveling, and attending classes) and how to accomplish them.

After 4 months, the wait-list control group received the BTB intervention for 4 months and the initial BTB group received no further intervention. The researchers assessed all participants at the beginning of the study and reassessed them at 4 and 8 months.

What did the researchers find?

After 4 months, participants in the BTB group had reduced depression severity, as scored by the PHQ-9. They also had improved mood and quality of life, less anxiety, better functioning in daily life, and more involvement in rewarding activities. In all, 44% of participants in the BTB group compared with 27% of those in the wait-list group had entered remission, defined as scoring 4 or less on the PHQ-9.

At 8 months, participants in the wait-list control group who started treatment at 4 months had benefits similar to those of participants in the initial BTB group. Many of the participants in the initial BTB group maintained the benefits from the initial treatment. Almost 70% of BTB participants who were in remission at 4 months remained so at 8 months.

What were the limitations of the study?

The BTB intervention was tested in a single urban senior center, and the number of study participants was small. The study was too short to determine the long-term effects of the intervention.

What are the implications of the study?

The BTB intervention may reduce depressive symptoms and enhance quality of life in older African Americans.





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