Case Management and Problem Solving Therapy for Depressed Older Adults

抑郁老年人的病例管理和问题解决疗法

• 批准号: 9248836
• 负责人: Brooke Ann Hollister
• 金额: $ 47.51万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9248836
• 关键词: Activities of Daily Living; Admission activity; Behavior Therapy; Budgets; Case Management; Chronic Disease; Clinical; Clinical effectiveness; Communities; Data; Depressed mood; Diagnosis; Dietary intake; Dropout; Effectiveness; Elderly; Evaluation; Evidence based intervention; Executive Dysfunction; Feeling hopeless; Geography; Health Professional; Healthcare Systems; Hospitalization; Housing; Impairment; Institutionalization; Intervention; Interview; Loneliness; Low income; Major Depressive Disorder; Medical; Mental Depression; Mental Health; Modeling; Nursing Homes; Outcome; Participant; Pilot Projects; Poverty; Problem Solving; Process; Professional counselor; Psychotherapy; Public Health; Research; Research Infrastructure; Research Personnel; Resolution; Resources; Risk; Rural; Rural Community; Self Efficacy; Sensory; Services; Social support; Surveys; Therapeutic Intervention; Training; Transportation; World Health Organization Disability Assessment Schedule; cost; depressive symptoms; disability; disability burden; effective therapy; evidence base; experience; functional disability; functional outcomes; geriatric depression; improved; improved functioning; mortality; nonmetropolitan area; peer; problem solving therapy; public health relevance; relative effectiveness; resilience; rural dwelling; rural setting; satisfaction; skills; urban setting

DESCRIPTION (provided by applicant): This is a proposal from a new and early stage investigator that will evaluate the effectiveness of Case Management-Problem Solving Therapy (CM-PST) and Self-Guided Problem Solving Therapy (SG-PST) for depressed older adults living in a rural community. PST is a behavioral treatment for late life depression proven effective in urban settings with ambulatory and medically ill older adults; older adults with executive dysfunctions; and low-income older adults with a disability when combined with clinical case management (CM-PST) through the CARE-D project (PI: Arean; MH075900). Furthermore, PST and CM-PST have been shown to improve functioning, and may improve self-efficacy and resiliency in depressed older adults, thereby decreasing their risk of institutionalization. Neither PST nor CM-PST has been studied in depressed older adults living in rural settings. Implementing CM-PST in a rural community will likely be challenged by a lack of mental health clinicians, and the fragmented state of rural mental health care systems. A potentially low-cost way to overcome these barriers is to use Senior Peer Counselors to support participant's use of self- guided PST (SG-PST). The main objectives are to examine the clinical effectiveness of CM-PST in reducing depressive symptoms and improving functional ability of older adults in a rural community; compare outcomes in a rural community to those in an urban community (data from the proposed and CARE-D projects); examine the relative effectiveness of CM-PST and SG-PST interventions in a rural community; and explore the feasibility of implementing CM-PST and SG-PST in a rural community through a process evaluation. Geographic Clinical Aims (rural vs. urban): 1. Evaluate effect of CM-PST on depressive symptoms (HDRS) in rural older adults suffering from major depression. 2. Evaluate effect of CM-PST on functional ability (WHODAS) in rural older adults suffering from major depression. 3. Determine if depression and functional effects in rural settings (year 5 outcomes from proposed project) are non-inferior to effects in urban settings (CARE-D project). Translational Clinical Aims (CM-PST vs. SG-PST): 4. Among rural-dwelling older adults, determine if depression and functional outcomes of the SG-PST intervention are non-inferior to outcomes of the CM-PST intervention. Translational Implementation Aims (CM-PST vs. SG-PST): 5. Evaluate acceptability (refusal rate, dropout rate, satisfaction), barriers (collected from participant exit surveys and implementation process interviews), fidelity to the intervention models (CM-PSTAS, CMAS), and cost (direct services budget per participant) of implementing CM-PST and SG-PST in a rural setting.

描述（由申请人提供）：这是一个新的和早期阶段的研究者的建议，将评估病例管理问题解决疗法（CM-PST）和自我指导问题解决疗法（SG-PST）的有效性生活在农村社区的抑郁老年人。PST是一种针对老年抑郁症的行为治疗，在城市环境中被证明是有效的，其中包括非卧床和患有医学疾病的老年人;患有执行功能障碍的老年人;以及通过CARE-D项目（PI：Arean; MH 075900）与临床病例管理（CM-PST）相结合的低收入老年人。此外，PST和CM-PST已被证明可以改善功能，并可能提高抑郁老年人的自我效能和弹性，从而降低他们的机构化风险。PST和CM-PST都没有在生活在农村的抑郁老年人中进行过研究。在农村社区实施CM-PST可能会受到缺乏精神卫生临床医生和农村精神卫生保健系统分散状态的挑战。克服这些障碍的一个潜在的低成本方法是使用高级同伴辅导员来支持参与者使用自我指导PST（SG-PST）。主要目的是检验CM-PST在农村社区减少老年人抑郁症状和改善功能能力方面的临床有效性;比较农村社区和城市社区的结果（数据来自拟议的和CARE-D项目）;检查CM-PST和SG-PST干预措施在农村社区的相对有效性;并通过过程评价探讨在农村社区实施CM-PST和SG-PST的可行性。地理临床目标（农村与城市）：1。评估CM-PST对农村老年抑郁症患者抑郁症状（HDRS）的影响。2.评估CM-PST对农村老年抑郁症患者功能能力（WHODAS）的影响。3.确定农村环境中的抑郁和功能影响（拟议项目的第5年结果）是否不劣于城市环境中的影响（CARE-D项目）。转化临床目的（CM-PST vs. SG-PST）：4。在农村居住的老年人中，确定SG-PST干预的抑郁和功能结果是否不劣于CM-PST干预的结果。翻译实施目标（CM-PST与SG-PST）：5.评估在农村环境中实施CM-PST和SG-PST的可接受性（拒绝率、辍学率、满意度）、障碍（从参与者退出调查和实施过程访谈中收集）、对干预模式的忠诚度（CM-PSTAS、CMAS）和成本（每位参与者的直接服务预算）。