Improving Depression Treatment for Older Minority Adults

NCT ID: NCT00570427

Last Updated: 2009-02-25

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2007-02-28
• Study Completion Date: 2008-06-30

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.

Conditions

Depression

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

1.

All participants

Group Type: EXPERIMENTAL

Problem Solving Therapy (PST)

Intervention Type: BEHAVIORAL

Counseling

Medication Management

Intervention Type: BEHAVIORAL

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.

Interventions

Problem Solving Therapy (PST)

Counseling

Intervention Type: BEHAVIORAL

Medication Management

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.

Intervention Type: BEHAVIORAL

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

• Minimum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of California, Los Angeles

OTHER

Sponsor Role: collaborator

National Institute on Aging (NIA)

NIH

Sponsor Role: lead

Responsible Party

Keck School of Medicine, University of Southern California

Principal Investigators

Isabel T. Lagomasino, MD MSHS

Role: PRINCIPAL_INVESTIGATOR

Department of Psychiatry, Keck School of Medicine, University of Southern California

Locations

LAC+USC Medical Center Geriatric Clinic

Los Angeles, California, United States

Countries

United States

References

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.

Reference Type: BACKGROUND

PMID: 17484933 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 17325113 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 16339612 (View on PubMed)

Other Identifiers

5P30AG021684

Identifier Type: NIH

Identifier Source: secondary_id

View Link

1557 G GD102

Identifier Type: -

Identifier Source: secondary_id

AG0091

Identifier Type: -

Identifier Source: org_study_id