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Original Research |

A Home-Based Intervention to Reduce Depressive Symptoms and Improve Quality of Life in Older African Americans: A Randomized Trial

Laura N. Gitlin, PhD; Lynn Fields Harris, MPA; Megan C. McCoy, MSS, MLSP; Nancy L. Chernett, MPH; Laura T. Pizzi, PharmD, MPH; Eric Jutkowitz, BA; Edward Hess, MS; and Walter W. Hauck, PhD
[+] Article and Author Information

From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.

Note: The principal investigator (Dr. Gitlin) had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Acknowledgment: The authors thank the research staff, including interviewers, interventionists, and care managers, and the study participants for their contributions to the study.

Financial Support: By the National Institute of Mental Health (R01MH079814).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2550.

Reproducible Research Statement: Study protocol and statistical code: Not available. Data set: Available from Dr. Gitlin (e-mail, lgitlin1@jhu.edu).

Requests for Single Reprints: Laura N. Gitlin, PhD, Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 Wolfe Street, Suite 316, Baltimore, MD 21205; e-mail, lgitlin1@jhu.edu.

Current Author Addresses: Dr. Gitlin: Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 Wolfe Street, Suite 316, Baltimore, MD 21205.

Ms. Fields Harris and Ms. McCoy: Center in the Park, 5818 Germantown Avenue, Philadelphia, PA 19144.

Ms. Chernett: Jefferson School of Population Health, Thomas Jefferson University, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107.

Dr. Pizzi: Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, 130 South 9th Street, Suite 1540, Philadelphia, PA 19107.

Mr. Jutkowitz: University of Minnesota, Health Policy and Management, 420 Delaware Street SE, MMC 729, Minneapolis, MN 55455.

Mr. Hess: University Hospital, 13611 East Colfax Avenue, Aurora, CO 80045.

Dr. Hauck: Sycamore Consulting, 5992 Pidcock Creek Road, New Hope, PA 18938.

Author Contributions: Conception and design: L.N. Gitlin, L. Fields Harris, N.L. Chernett, W.W. Hauck.

Analysis and interpretation of the data: L.N. Gitlin, W.W. Hauck, E. Hess.

Drafting of the article: L.N. Gitlin, W.W. Hauck, E. Hess.

Critical revision of the article for important intellectual content: L.N. Gitlin, L. Fields Harris, L.T. Pizzi, E. Hess.

Final approval of the article: L.N. Gitlin, L. Fields Harris, M.C. McCoy, N.L. Chernett, L.T. Pizzi, E. Jutkowitz, E. Hess.

Provision of study materials or patients: L.N. Gitlin.

Statistical expertise: E. Hess, W.W. Hauck.

Obtaining of funding: L.N. Gitlin.

Administrative, technical, or logistic support: L.N. Gitlin, L. Fields Harris, N.L. Chernett, L.T. Pizzi, E. Jutkowitz.

Collection and assembly of data: L.N. Gitlin, M.C. McCoy, N.L. Chernett, E. Hess.


Ann Intern Med. 2013;159(4):243-252. doi:10.7326/0003-4819-159-4-201308200-00005
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Chinese translation

Background: Effective care models for treating older African Americans with depressive symptoms are needed.

Objective: To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.

Design: Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680)

Setting: A senior center and participants' homes from 2008 to 2010.

Patients: African Americans aged 55 years or older with depressive symptoms.

Intervention: A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months.

Measurements: Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months.

Results: Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, −2.9 [95% CI, −4.6 to −1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, −3.7 [CI, −5.4 to −2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months.

Limitation: The study had a small sample, short duration, and differential withdrawal rate.

Conclusion: A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans.

Primary Funding Source: National Institute of Mental Health.

Figures

Grahic Jump Location
Figure.

Study flow diagram.

BTB = Beat the Blues; IHSP = In-Home Support Program.

* Three participants had 8-mo follow-up but missed 4-mo follow-up.

† One participant had 8-mo follow-up but missed 4-mo follow-up.

Grahic Jump Location

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Summary for Patients

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

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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