Case Management and PST for Depressed Homebound Low-Income Elders

描述（由申请人提供）：本研究旨在比较个案管理结合问题解决疗法（CM-PST）与单独个案管理（CM）在患有严重抑郁症、残疾和解决问题困难的家庭送餐服务低收入老年人中的疗效。我们专注于膳食接受者，因为他们经常受到抑郁症的困扰，因为他们的临床状态的复杂性加上他们的经济限制，为护理带来了巨大的挑战。临床逻辑和新兴的实证数据表明，整合CM与PST可能有协同效应，在抑郁的低收入老人CM可以帮助他们与他们的社会经济需求和PST可以提高他们的能力，以应付慢性压力源和利用他们的新资源。参与者将是200名（每个中心100名）老年（> 64岁）非精神病、非痴呆的单相重度抑郁症家庭送餐接受者，他们将被随机分配接受12次CM-PST或CM。这项研究旨在测试CM-PST在减少抑郁症状和残疾方面比CM更有效的假设;这两种治疗都将由家庭送餐服务的训练有素的个案工作者在客户家中提供。此外，我们假设这些影响是通过改进替代解决方案和决策来介导的。虽然我们意识到研究“病人，残疾人和老年人”所带来的方法学问题和困惑，但我们为这个项目带来了两组在两中心心理治疗研究中成功合作的历史，在治疗研究和心理治疗研究方面的互补专业知识，以及指导多中心研究的经验。此外，该项目将得到康奈尔大学高级干预和服务研究中心（ACISR）的支持，该中心的主要目标是针对具有特定临床和生物学特征的抑郁症老年人制定治疗干预措施。因此，我们有能力迎接这一困难但重要的研究领域所固有的挑战。如果CM-PST被发现有效，它可以由受过训练的社会服务个案工作者提供给大量抑郁的、居家的、低收入的老年人。

DESCRIPTION (provided by applicant): This study proposes to compare the efficacy of Case Management combined with Problem Solving Therapy (CM-PST) to that of Case Management alone (CM) in low-income elderly recipients of Home-Delivered Meals Services with major depression, disability and problem solving difficulties. We focus on meals recipients because they are often afflicted by depression and because the complexity of their clinical state coupled with their financial limitations creates a formidable challenge for care. Clinical logic and emerging empirical data suggest that integrating CM with PST may have a synergistic effect in depressed low-income elders as CM can help them with their socioeconomic needs and PST can improve their ability to cope with chronic stressors and utilize their new resources. The participants will be 200 (100 from each Center) elderly (>64 years) non-psychotic, non-demented Home-Delivered Meals recipients with unipolar major depression who will be randomly assigned to receive 12 sessions of CM-PST or CM. The study is designed to test the hypotheses that CM-PST is more effective than CM in reducing depressive symptoms and disability; both treatments will be delivered at the clients' homes by trained case workers of the Home-Delivered Meals Services. Furthermore, we hypothesize that these effects are mediated by improvement in generation of alternative solutions, and decision-making. While we are aware of the methodological problems and confounds posed by studying a "sick, disabled, and old population", we bring to this project two groups with a history of a successful collaboration in a two-center psychotherapy study, complementary expertise in treatment studies and psychotherapy research, and experience in directing multicenter studies. Moreover, the project will be supported by the structures of the Cornell Advanced Center for Interventions and Services Research (ACISR), whose principal objective is to develop treatment interventions targeting depressed elders with specific clinical and biological characteristics. Accordingly, we are well positioned to meet the challenges inherent in this difficult but important area of research. If CM-PST were found efficacious, it may be offered by trained case-workers of social services to large numbers of depressed, homebound, low-income elders.