Developmental Project 1: EM/PROTECT: Improving Depression in Elder Mistreatment Victims

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EM/PROTECT Study Abstract Elder mistreatment afflicts up to 10% of adults 60 years and older. Approximately 1/3 of victims have clinically significant depressive symptoms. We developed EM/PROTECT, a behavioral intervention for depressed EM victims to work in synergy with EM mistreatment resolution services that provide safety planning, support services, and linkages to legal services. PROTECT is built on a model, which postulates that chronic stress promotes dysfunction of the cognitive control (CCN) and the reward networks impairing the victims' ability to flexibly respond to the environment and limits their rewarding activities. EM/PROTECT utilizes simple to use mobile technology to support the victim's action plans, help therapists to target their sessions, and track mood, stress and social interaction. EM/PROTECT has been designed in an iterative process with community EM providers of the NYC Department for the Aging (DFTA) to use agencies' routine PHQ-9 depression screening and referral for services. This project will examine the reach, feasibility, acceptability, and preliminary effectiveness of EM/PROTECT with the goal of building a sustainable mental health program that can be broadly implemented. Our primary hypotheses postulate that victims who receive EM services and PROTECT therapy (EM/PROTECT) will have greater reduction in depression and improvement in quality of life compared to victims who receive EM Services and a mental health referral (EM-MH). We propose that reductions in stress will mediate the differential impact of EM/PROTECT. With two NYC EM agencies, we will develop procedures for PHQ-9 screening, hand-off, linkages, consent process, tracking of EM actions, and clinical progress. EM victims will be recruited from two randomly assigned EM agencies that will yield a sample of 60 subjects (40 EM/PROTECT and 20 EM-MH). Research assessments will be conducted at baseline, 6, 9 and 12 weeks to evaluate depression, quality of Life, chronic stress, rewarding activities and incidents of financial, physical and psychological abuse and neglect. We will assess reach by recording the rates of screening, identified depressed victims, referrals to each condition, refusal and lack of follow-through; feasibility of EM/PROTECT will be based on drop-out, completion of assessments, and use of smartphones; and acceptability will be based on client satisfaction. We will analyze measures of effectiveness in separate linear mixed models with a subject-specific random intercept and slope and fixed effects for time, treatment, and EM agency. The results of this project will be used to support an R01 application to formally test the feasibility, acceptability, effectiveness, non-billable costs, and barriers to implementation of PROTECT in in a rigorous randomized controlled trial. We plan to conduct the trial with EM agencies nationwide.