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

Abstract

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.

Mediators of the impact of a home-based intervention (beat the blues) on depressive symptoms among older African Americans.

“…We examined whether the effects of four factors, depression knowledge/efficacy in symptom recognition, anxiety, behavioral activation, and formal service use mediated the relationship between intervention participation and the impact on depressive symptoms as measured by two indicators. Similar to our previous report involving the entire sample (Gitlin et al, 2013), results of these analyses confirmed that BTB had significant positive effects on depressive symptoms, and on three of four mediators. BTB reduced anxiety, and enhanced depression knowledge/symptom recognition and behavioral activation, all important outcomes for this group of older adults.…”

“…Following treatment, control group participants demonstrated benefits (4 to 8-months) similar in magnitude to the adjusted treatment effects for BTB participants in the first 4-months; and the initial BTB group maintained 4-month benefits at 8-months (Gitlin et al, 2013). …”

Cost‐Effectiveness of a Community‐Integrated Home‐Based Depression Intervention in Older African Americans

“…Additionally, at 4 months, 44% of BTB participants were in remission compared with 27% of wait-listed controls. 27 …”

Merging Person-Centered Care With Translational Research to Improve the Lives of Older Adults: Creating Community-Based Nursing Research Networks

“…Following the four-month multi-component, home-based intervention, participants in the intervention group were more likely than controls to enter remission. They also demonstrated clinical meaningful reductions in depression severity, as well as improved mood, quality of life, and depression knowledge (Gitlin et al, 2013). From development of the intervention through connecting with a difficult to reach target group for intervention delivery, community-engaged research methods were crucial to Beat the Blues’ success.…”