A Family-based Primary Care Intervention to Enhance Older Men's Depression Care
| Status: | Completed |
|---|---|
| Conditions: | Depression, Depression, Major Depression Disorder (MDD) |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 60 - Any |
| Updated: | 3/31/2017 |
| Start Date: | November 1, 2015 |
| End Date: | December 31, 2016 |
Despite the public health importance of clinical depression, more than 50% of depressed
adults receive inadequate or no treatment, with even higher rates of under-treatment in men
and minorities. Family members and/or friends often assist older adults in their health care
and may help overcome barriers to formal care, yet there is a lack of primary care-based
interventions that mobilize family members and friends to improve depression treatment. In
partnership with a community-based clinic, this research will address this scientific gap by
developing and then testing the feasibility and acceptability of a family-based intervention
that can be delivered pragmatically in a primary care setting serving large numbers of older
minorities.
adults receive inadequate or no treatment, with even higher rates of under-treatment in men
and minorities. Family members and/or friends often assist older adults in their health care
and may help overcome barriers to formal care, yet there is a lack of primary care-based
interventions that mobilize family members and friends to improve depression treatment. In
partnership with a community-based clinic, this research will address this scientific gap by
developing and then testing the feasibility and acceptability of a family-based intervention
that can be delivered pragmatically in a primary care setting serving large numbers of older
minorities.
The family-based intervention will be tested in a 6 month randomized controlled trial of 24
depressed older men-family member dyads (18 intervention and 6 controls). The purpose of the
RCT is to test the acceptability of the intervention, as well as the feasibility of the
study methods. Patients from the RCT will be identified from a family practice clinic based
on their scores on the PHQ-9 as well as additional inclusion and exclusion criteria. Once
they and their family member have agreed to participate, patients will be randomized either
to the family based intervention or a usual care control condition augmented by family
psychoeducation. The investigators will recruit English and Spanish speaking age 60 and
above older men from SJGH who have 1) significant depressive symptoms (i.e. PHQ > 15, 2)
have at least one criteria A symptom (depressed mood or anhedonia), 3) depression-related
functional impairment) and 4) an adult family member willing to participate in the study. We
have chosen a higher cut-off to minimize false positives. We will exclude psychotic,
demented or institutionalized men. After enrollment, 24 dyads (i.e. older man and family
member) will be randomized one of two groups: intervention or usual care augmented by
written psychoeducational materials on depression. Dyads will be randomized to achieve a 2:1
ratio of intervention versus usual care dyads (i.e. 18 intervention and 6 control dyads). To
ensure adequate numbers of ethnic minority patients in each arm of the trial, we will
conduct a stratified randomization such that each arm of the RCT is 50% English language
preferring and 50% Spanish language preferring (i.e. 3 in control and 9 in intervention
arm). The research assistant will conduct subject assessment at baseline, 1-month, 3-months
and 6 months.
depressed older men-family member dyads (18 intervention and 6 controls). The purpose of the
RCT is to test the acceptability of the intervention, as well as the feasibility of the
study methods. Patients from the RCT will be identified from a family practice clinic based
on their scores on the PHQ-9 as well as additional inclusion and exclusion criteria. Once
they and their family member have agreed to participate, patients will be randomized either
to the family based intervention or a usual care control condition augmented by family
psychoeducation. The investigators will recruit English and Spanish speaking age 60 and
above older men from SJGH who have 1) significant depressive symptoms (i.e. PHQ > 15, 2)
have at least one criteria A symptom (depressed mood or anhedonia), 3) depression-related
functional impairment) and 4) an adult family member willing to participate in the study. We
have chosen a higher cut-off to minimize false positives. We will exclude psychotic,
demented or institutionalized men. After enrollment, 24 dyads (i.e. older man and family
member) will be randomized one of two groups: intervention or usual care augmented by
written psychoeducational materials on depression. Dyads will be randomized to achieve a 2:1
ratio of intervention versus usual care dyads (i.e. 18 intervention and 6 control dyads). To
ensure adequate numbers of ethnic minority patients in each arm of the trial, we will
conduct a stratified randomization such that each arm of the RCT is 50% English language
preferring and 50% Spanish language preferring (i.e. 3 in control and 9 in intervention
arm). The research assistant will conduct subject assessment at baseline, 1-month, 3-months
and 6 months.
Inclusion Criteria:
- men, age 60 and above, English or Spanish speaking, significant depressive symptoms
(i.e. PHQ > 15, have at least one criteria A symptom (depressed mood or anhedonia),
depression-related functional impairment, have an adult family member willing to
participate in the study
Exclusion Criteria:
- psychotic, demented, institutionalized
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