Intervention to Reduce Depression Among Elder Abuse Victims: Type 1 Hybrid Trial of Tele-PROTECT

项目摘要 世界卫生组织估计，每6名60岁以上的成年人中就有1人是 在过去的一年里成为虐待的受害者。我们的研究表明，其中近三分之一的人 受害者有明显的临床抑郁症状，16%有自杀念头(Sirey et Al.，2015)。远程保护，是唯一为虐待老人受害者提供的手动虚拟治疗 正经历着抑郁。它在受害者接受服务的同时提供给他们 来自提供安全规划、支持服务和法律服务的虐待老年人机构。电传- Protect采用以部署为重点的方法设计，我们的合作伙伴在New 纽约市老年局(DFTA)。远程保护战略的重点是增加 减少抑郁的愉快和有益的活动，以及设定目标和定义 行动步骤，以增加与安全相关的授权。在我们的随机对照试验项目中， 接受保护的参与者抑郁症状显著减少，因为 与处于转诊控制条件下的患者相比(Sirey等人，2021年)。我们的前期工作 在疫情期间，展示了虚拟交付的可行性和有效性 通过视频(称为远程保护)向大量不同的受害者提供保护。 该项目将测试远程保护的有效性，并将其与视频传输进行比较 注意控制条件(DepED)。我们将招募140名会说英语和西班牙语的老年人 来自纽约市五家虐待老人机构的虐待受害者。我们假设Tele- 保护参与者将体验到抑郁症状的更大减少和更大的 与注意力控制(DepED)相比，与安全相关的授权增加。 虐待老年人机构的工作人员将转介同意研究人员的抑郁受害者。合资格 同意、有基线评估并符合纳入标准的虐待长者受害者将 被随机分配到远程保护或DepED。后续评估将在以下地点进行 基线后第3、6、9和12周。训练有素的研究助理盲目研究假设 还将评估抑郁严重程度(MADR)和与安全相关的授权(MOVER) 作为参与活动、社会隔离和刑事司法的结果。与 一个全国性的虐待老人机构组织(NAPSA)，我们将使用混合方法设计 与多个利益相关者小组一起收集有关障碍和促进者的数据 在全国范围内实施远程保护。远程保护已经证明是可行的， 可接受性和初步有效性。该项目将测试一种可扩展的人工治疗方法 有可能在全国范围内实施，为虐待老年人的抑郁受害者提供服务。

PROJECT ABSTRACT The World Health Organization estimates that 1 in 6 adults over the age of 60 has been a victim of abuse in the past year. Our research demonstrated that nearly one-third of these victims have clinically significant depressive symptoms and 16% have suicidal ideation (Sirey et al., 2015). Tele-PROTECT, is the only manualized, virtual therapy for elder abuse victims experiencing depression. It is offered to victims at the same time that they are receiving services from elder abuse agencies that offer safety planning, support services, and legal services. Tele- PROTECT was designed using a deployment-focused approach with our partners at the New York City Department for the Aging (DFTA). Tele-PROTECT strategies focus on increasing pleasurable and rewarding activities to reduce depression, and goal setting and defining the action steps to increase safety related empowerment. In our randomized controlled pilot project, participants receiving PROTECT had significant decreases in symptoms of depression as compared to those in the referral control condition (Sirey et al., 2021). Our preliminary work during the pandemic, demonstrated the feasibility and effectiveness of virtual delivery of PROTECT via video (called Tele-PROTECT) to a large sample of diverse victims. This project will test the effectiveness of Tele-PROTECT as compared to a video-delivered attention control condition (DepEd). We will recruit 140 English- and Spanish-speaking elder abuse victims from five New York City (NYC) elder abuse agencies. We hypothesize that Tele- PROTECT participants will experience greater decreases in depressive symptoms and greater increase in safety-related empowerment compared to an attention control (DepEd). Elder abuse agency staff will refer depressed victims who agree to research staff. Eligible elder abuse victims who consent, have a baseline assessment and meet inclusion criteria will be randomized to Tele-PROTECT or DepEd. Follow up assessments will be conducted at weeks 3, 6, 9, and 12 after baseline. Trained Research Assistants blinded to study hypotheses will assess depression severity (MADRS) and safety-related empowerment (MOVERS), as well as participation in activities, social isolation, and criminal justice outcomes. In collaboration with a national organization of elder abuse agencies (NAPSA), we will use a mixed methods design with multiple stakeholder groups to collect data on the barriers and facilitators to the implementation of Tele-PROTECT nationally. Tele-PROTECT has demonstrated feasibility, acceptability, and preliminary effectiveness. This project will test a scalable manualized therapy with the potential for national implementation to serve depressed victims of elder abuse.