A community-integrated home based depression intervention for older African Americans: descripton of the Beat the Blues randomized trial and intervention costs

BMC Geriatrics

Study Protocol

Lynn Fields Harris¹  Megan McCoy¹  Laura N Gitlin²  Nancy L Chernett³  Laura T Pizzi³  Eric Jutkowitz⁴ 

[1] Center in the Park, 5818 Germantown Avenue, 19144, Philadelphia, PA, USA;Johns Hopkins University, 525 Wolf Street, 21205, Baltimore, Maryland, USA;Thomas Jefferson University, 1015 Walnut Street, Suite 115, 19107, Philadelphia, PA, USA;University of Minnesota, Health Policy and Management, 420 Delaware Street SE, MMC 729Minneapolis, 55455, MN, USA;

关键词: Depressive Symptom;    Behavioral Activation;    Depression Treatment;    Patient Health Questionnaire;    Depression Screening;   

DOI  :  10.1186/1471-2318-12-4

 received in 2011-10-10, accepted in 2012-02-10,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPrimary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness.Methods/DesignBeat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55+ years old. It involves a collaboration with a senior center whose care management staff screen for depressive symptoms (telephone or in-person) using the Patient Health Questionnaire (PHQ-9). Individuals screened positive (PHQ-9 ≥ 5) on two separate occasions over 2 weeks are referred to local mental health resources and BTB. Interested and eligible participants who consent receive a baseline home interview and then are randomly assigned to receive BTB immediately or 4 months later (wait-list control). All participants are interviewed at 4 (main study endpoint) and 8 months at home by assessors masked to study assignment. Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs, make referrals/linkages, provide depression education, instruct in stress reduction techniques, and use behavioral activation to identify goals and steps to achieve them. Key outcomes include reduced depressive symptoms (primary), reduced anxiety and functional disability, improved quality of life, and enhanced depression knowledge and behavioral activation (secondary). Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions. Cost and cost effectiveness is being evaluated.DiscussionBTB is designed to bridge gaps in mental health service access and treatments for older African Americans. Treatment components are tailored to specific care needs, depression knowledge, preference for stress reduction techniques, and personal activity goals. Total costs are $584.64/4 months; or $146.16 per participant/per month.Trial RegistrationClinicalTrials.gov #NCT00511680

【 授权许可】

CC BY   
© Gitlin et al; licensee BioMed Central Ltd. 2012