Home Care Helps Older Blacks with Depression

Published: Aug 19, 2013 By Cole Petrochko, Staff Writer, MedPage Today Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner Action Points • Note that this randomized trial demonstrated that an intensive, home-based, social worker intervention helped to alleviate symptoms of depression in older African Americans. • Be aware that the cost-efficacy of such interventions has yet to be evaluated. A home-based intervention for depressive symptoms in older African-American patients reduced depression severity, improved knowledge about depression, and raised patients' quality of life, researchers found. Compared with those wait-listed for the intervention, patients who received at-home care saw mean depression scores fall by 2.9 points (95% CI minus 4.6-minus 1.2) on one scale and by 3.7 points (95% CI minus 5.4-minus 2.1) on another scale, according to Laura Gitlin, PhD, of Johns Hopkins University School of Nursing, and colleagues. Those who received home-based care also had significantly improved quality of life, behavioral activation, and anxiety (P<0.001 for each) versus those who had not yet received the intervention, they wrote in the August 20 issue of Annals of Internal Medicine. The authors noted that depression is both common and has "debilitating consequences" in older patients, and that the condition is both under-recognized and under-treated in primary care settings among older African-American patients versus older white patients. White patients are more likely to receive standard depression care and to participate in psychotherapy and other guideline treatments, they wrote, adding that this disparity is due to systemic- and patient-level problems, such as lack of access to care and stigma associated with treatment. The researchers evaluated whether a home-based, social worker-delivered intervention -- which they titled "Beat the Blues" -- would manage depressive symptoms in a population of 208 African Americans ages 55 and older who were randomized to treatment or to a wait list for treatment. Participants in the intervention group received up to 10 1-hour sessions at home that were delivered weekly over the first 4 months and biweekly after that period. Social workers in the intervention offered care management through a "systematic assessment of unmet care needs," referrals to social and medical services, depression education in symptom recognition, education in stress reduction techniques, and education in behavioral activation through identification of personal activity goals and plans to accomplish them. Treatment goals included management of chronic conditions, socialization, exercise, and meeting unmet care needs. Those randomized to the wait list control received no study-based care over the baseline to 4-month study period, though they were offered the at-home intervention after 4 months. Study outcomes included improvement in depressive symptom severity as measured through the Patient Health Questionnaire-9 and the Epidemiologic Studies Depression Scale, as well as improvement of depression knowledge, well-being, quality of life, behavioral activation, anxiety, and functional difficulty. Participants had a mean age of 69.6; most were women (78.4%) and were unemployed (90.9%). Most were unmarried, lived alone, had some financial difficulty, and had no more than a high school education. Most participants also had high blood pressure, arthritis, and high cholesterol; diabetes was also common. Roughly one in five took antidepressants (19.3%) or anti-anxiety drugs (17%). After 4 months of treatment, depressive symptom scores -- as well as secondary outcomes improved for patients in the intervention group versus control participants. Improvements (P<0.001 for all) included: Depression knowledge and efficacy (an 0.3-point improvement) • Well being (0.7 points) • Behavior activation (0.8 points) • Quality of life (0.3 points) • Anxiety (-0.4 points) Functional difficulty scores dropped by 0.2 points, but this difference was not as strong (P=0.014). More patients who received treatment had remission of depressive symptoms compared with those who were wait-listed (43.8% versus 26.9%), and more had clinically meaningful reductions in depressive symptom severity (64% versus 40.9%). After 8 months, participants in the control group who had received at-home treatment "showed benefits ... that were similar to the adjusted benefits from the initial treatment group." Additionally, among those who received treatment in the first 4 months of the study, 68.6% were still in remission at 8 months' follow-up. The authors cautioned that the withdrawal rate was higher in the treatment group than in the wait-listed group. They also noted the study was limited by its use of a single-center, self-reported outcomes, a small study sample, a small number of male participants, and use of a single minority group. The study was supported by the National Institute of Mental Health. Primary source: Annals of Internal Medicine Source reference: Gitlin LN, et al "A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans" Ann Intern Med 2013: DOI: 10.7326/0003-4819-159-4-201308200-00005. http://www.medpagetoday.com/Geriatrics/Depression/41068?xid=nl_mpt_DHE_2013-08-20&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g350341d0r&userid=350341&email=john@thebrokerageinc.com&mu_id=5344066