Case Management and PST for Depressed Homebound Low-Income Elders

描述(由申请人提供)：本研究建议比较个案管理结合问题解决疗法(CM-PST)与单纯个案管理(CM)在接受家庭式膳食服务的低收入长者中的疗效，这些受助人有严重的抑郁、残疾和问题解决困难。我们关注餐食接受者，因为他们经常受到抑郁症的困扰，因为他们临床状态的复杂性，加上他们的经济限制，给护理带来了巨大的挑战。临床逻辑和新出现的经验数据表明，将中医和PST结合起来可能对抑郁的低收入老年人具有协同效应，因为CM可以帮助他们满足他们的社会经济需求，PST可以提高他们应对慢性应激源和利用新资源的能力。参与者将是200名(每个中心100名)老年(&gt；岁)非精神病、非痴呆、单相重度抑郁症的家庭助餐接受者，他们将被随机分配接受12个疗程的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；这两种治疗方法都将由家庭递送餐饮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的生成和决策来实现的。虽然我们意识到研究“病人、残疾人和老年人”所带来的方法问题和混乱，但我们为这个项目带来了两个小组，他们在两个中心的心理治疗研究中有成功合作的历史，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干预和服务研究高级中心(ACISR)结构的支持，该中心的主要目标是开发针对具有特定临床和生物学特征的抑郁症老年人的治疗干预措施。因此，我们处于有利地位，能够迎接这一困难但重要的研究领域所固有的挑战。如果CM-PST被发现是有效的，它可能会由训练有素的社会服务个案工作者提供给大量抑郁、呆在家里、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.