EM/PROTECT: Improving Depression in Elder Mistreatment Victims
| Status: | Recruiting |
|---|---|
| Conditions: | Depression, Depression |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 55 - 100 |
| Updated: | 2/17/2019 |
| Start Date: | January 1, 2018 |
| End Date: | June 30, 2019 |
| Contact: | Jo Anne Sirey, Ph.D. |
| Email: | jsirey@med.cornell.edu |
| Phone: | 914-997-4333 |
The investigators developed EM/PROTECT, a behavioral intervention for depressed EM (elderly
mistreatment) victims, to work in synergy with EM mistreatment resolution services that
provide safety planning, support services, and links to legal services. PROTECT is built on a
model which postulates that chronic stress promotes dysfunction of the cognitive control
(CCN) and reward networks, impairing the victims' ability to flexibly respond to the
environment and limits their reward activities. PROTECT therapists work with victims to
develop action plans to reduce stress, and to increase rewarding experiences. EM/PROTECT has
been designed in an iterative process with community EM providers of the New York City (NYC)
Department for the Aging (DFTA) to use agencies' routine PHQ-9 depression screening and
referral for service. In the current study, the investigators will compare the effectiveness
of EM/PROTECT with EM enriched with staff training in linking EM victims to community mental
health services (EM/MH). The investigators intend to enroll 80 subjects that will participate
in the study for approximately 12 weeks.
mistreatment) victims, to work in synergy with EM mistreatment resolution services that
provide safety planning, support services, and links to legal services. PROTECT is built on a
model which postulates that chronic stress promotes dysfunction of the cognitive control
(CCN) and reward networks, impairing the victims' ability to flexibly respond to the
environment and limits their reward activities. PROTECT therapists work with victims to
develop action plans to reduce stress, and to increase rewarding experiences. EM/PROTECT has
been designed in an iterative process with community EM providers of the New York City (NYC)
Department for the Aging (DFTA) to use agencies' routine PHQ-9 depression screening and
referral for service. In the current study, the investigators will compare the effectiveness
of EM/PROTECT with EM enriched with staff training in linking EM victims to community mental
health services (EM/MH). The investigators intend to enroll 80 subjects that will participate
in the study for approximately 12 weeks.
One in ten older adults is a victim of mistreatment, and one third of victims have clinically
significant depressive symptoms. Depression increases mortality and decreases motivation to
take self-protective steps. Yet, no elder mistreatment (EM) agencies have embedded
identification and treatment of depressed EM victims in their programs. The investigators
developed EM/PROTECT, a behavioral intervention for depressed EM victims, to work in synergy
with EM agencies that provide safety planning and links to legal services. EM/PROTECT has
been designed in an iterative process with community EM providers of the NYC Department for
the Aging (DFTA), to utilize agencies' routine depression screening and service referrals.
The investigators propose to collect data on the feasibility and acceptability of EM/PROTECT
as one of three developmental projects under the ALACRITY Center NIMH grant (1 P50
MH113838-01,PI: Alexopoulos) (IRB 1704018108). We will compare the effectiveness of
EM/PROTECT with EM enriched with staff training in linking EM victims to community mental
health services (EM/MH). To ensure rigor and reproducibility, EM/PROTECT or EM/MH will be
offered to randomly assigned depressed EM victims. All EM victims will receive standard EM
resolution services from DFTA. EM staff will screen and refer depressed victims to Cornell
staff, who will describe the study and obtain consent. Standardized assessments will be
conducted by trained raters blind to participant assignment.
In addition, the investigators will use both active and passive sensing technology through
smartphone data collection to supplement in-person data collection with an objective measure
of socialization and behavioral activation. Smartphone data will be used to explore whether
adherence to active recordings and time spent carrying the phone is associated with greater
effectiveness of EM/PROTECT.
significant depressive symptoms. Depression increases mortality and decreases motivation to
take self-protective steps. Yet, no elder mistreatment (EM) agencies have embedded
identification and treatment of depressed EM victims in their programs. The investigators
developed EM/PROTECT, a behavioral intervention for depressed EM victims, to work in synergy
with EM agencies that provide safety planning and links to legal services. EM/PROTECT has
been designed in an iterative process with community EM providers of the NYC Department for
the Aging (DFTA), to utilize agencies' routine depression screening and service referrals.
The investigators propose to collect data on the feasibility and acceptability of EM/PROTECT
as one of three developmental projects under the ALACRITY Center NIMH grant (1 P50
MH113838-01,PI: Alexopoulos) (IRB 1704018108). We will compare the effectiveness of
EM/PROTECT with EM enriched with staff training in linking EM victims to community mental
health services (EM/MH). To ensure rigor and reproducibility, EM/PROTECT or EM/MH will be
offered to randomly assigned depressed EM victims. All EM victims will receive standard EM
resolution services from DFTA. EM staff will screen and refer depressed victims to Cornell
staff, who will describe the study and obtain consent. Standardized assessments will be
conducted by trained raters blind to participant assignment.
In addition, the investigators will use both active and passive sensing technology through
smartphone data collection to supplement in-person data collection with an objective measure
of socialization and behavioral activation. Smartphone data will be used to explore whether
adherence to active recordings and time spent carrying the phone is associated with greater
effectiveness of EM/PROTECT.
Inclusion Criteria:
- 55 years of age or older
- Capacity to consent (per EM staff)
- Significant depression (per EM staff) as indicated by a score of 10 or above on the
Patient Health Questionnaire-9 (PHQ-9), a widely used screening tool routinely
administered in EM agency settings (the PHQ-9 has a sensitivity of 88% and a
specificity of 88% for major depression)
- Need for EM services
Exclusion Criteria:
- Active suicidal ideation (MADRS item 10>4)
- Inability to speak English
- Axis 1 DSM-5 diagnoses other than unipolar depression or generalized anxiety disorder
(by SCID)
- Mini-Mental Exam score of 23 or less 5
- Severe or life-threatening medical illness
- EM emergency and or referral out of EM agency (per EM staff)
We found this trial at
2
sites
New York, New York 10007
Phone: 212-602-4180
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