Increasing Use of Mental Health Services by Community Dwelling Older Adults with

描述（由申请人提供）：抑郁症是对老年人的公共健康威胁。它增加了残疾、死亡和机构收容等有害后果的风险。10%接受上门送餐服务的老年人患有临床上显著的抑郁症。大多数被转介到精神卫生服务的抑郁老年人没有成功地获得护理。除了交通和成本等实际障碍之外，他们还面临心理障碍，例如对抑郁症及其护理的耻辱和信念。本申请的目的是测试治疗启动计划（TIP）的有效性，这是一种简短的心理社会干预，旨在解决抑郁社区老年人对护理的心理障碍，并改善他们对精神卫生服务的使用。干预措施旨在帮助老年人识别障碍，解决问题以找到解决方案，并调动寻求帮助的动机。TIP的开发是为了与患有抑郁症的老年人合作，以改善对心理健康治疗的获得和坚持。在先前的研究中，发现TIP可以改善治疗参与，减少抑郁症状，并增加初级保健和门诊精神病患者中抑郁老年人对抗抑郁治疗的依从性。我们建议进行一项随机对照试验，以确定TIP对参与家庭送餐计划的抑郁社区老年人获得护理（定义为参与）的影响。正在接受上门送餐并被筛选为抑郁症（PHQ-9>9）的老年人（N=160）将被随机分配到治疗启动计划（TIP）或转诊对照条件，即有交通安排的心理健康转诊。这项研究的目的是评估每种情况对心理健康治疗参与（定义为参加两次推荐的心理健康访问）和抑郁症状的影响。在拟定研究中，将对受试者进行6个月随访，并在基线评估后12周和24周进行评估。如果TIP被证明是有效的，它很有可能被我们的社区合作伙伴，韦斯特切斯特县高级项目和服务部维持。

DESCRIPTION (provided by applicant): Depression is a public health threat to older adults. It increases the risks of detrimental outcomes such as disability, mortality and institutionalization. 10% of older adults receiving home delivered meal service suffers from clinically significant depression. The majority of depressed elderly who are referred for mental health services do not successfully access care. Beyond the practical barriers of transportation and cost, they face psychological barriers, such as stigma and beliefs about depression and its care. The aim of this application is to test the effectiveness of the Treatment Initiation Program (TIP), a brief psychosocial intervention to address the psychological barriers to care and improve the use of mental health services by depressed community elderly. The intervention is designed to help the older adult identify the barriers, problem-solve to find solutions and mobilize the motivation to seek help. TIP was developed to work collaboratively with an older adult who is depressed to improve access and adherence to mental health treatment. In prior research TIP has been found to improve treatment participation, reduce depressive symptoms and increase adherence to antidepressant therapy among depressed older adults in primary care and outpatient psychiatric settings. We propose to conduct a randomized controlled trial to determine the impact of TIP on access to care, defined as engagement, among depressed community dwelling older adults participating in a home delivered meal program. Consenting older adults (N=160) who are receiving home delivered meals and are screened as depressed (PHQ-9>9), will be randomized to either the Treatment Initiation Program (TIP) or the Referral control condition, a mental health referral with transportation arrangements. The goal of the research is to evaluate the impact of each condition on mental health treatment engagement (defined as attending two recommended mental health visits) and depressive symptoms over the following six months. In the proposed study subjects will be followed for 6 months and assessed 12 and 24 weeks after baseline assessment. If TIP is demonstrated to be effective, it has a high likelihood of being sustained by our community partners, the Westchester County Department of Senior Programs and Services.