Improving Depression Treatment for Older Minority Adults

This study has been completed.
Sponsor:
Collaborator:
UCLA Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME)
Information provided by:
National Institute on Aging (NIA)
ClinicalTrials.gov Identifier:
NCT00570427
First received: December 7, 2007
Last updated: February 24, 2009
Last verified: February 2009
  Purpose

The purpose of this study is to improve access to quality depression care for older, low-income, minority adults in public sector health care. The study will examine current depression care in a public sector geriatric clinic that serves mostly Spanish-speaking Latinos and pilot study assessments and treatments in order to lay the groundwork for a large study of quality improvement for depressed older minorities


Condition Intervention
Depression
Behavioral: Problem Solving Therapy (PST)
Behavioral: Medication Management

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Improving Depression Treatment for Older Minority Adults

Resource links provided by NLM:


Further study details as provided by National Institute on Aging (NIA):

Primary Outcome Measures:
  • Depression severity, depression treatment preferences, and barriers to care [ Time Frame: baseline and 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Feasibility, acceptability, and effectiveness of intervention [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 30
Study Start Date: February 2007
Study Completion Date: June 2008
Primary Completion Date: June 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1.
All participants
Behavioral: Problem Solving Therapy (PST)
Counseling
Behavioral: Medication Management
If a participant chooses to receive antidepressant medication while in the study, a depression care specialist works with the participant's usual primary care provider to initiate an appropriate prescription and to follow-up with side effects, adherence, efficacy, etc. on a monthly or biweekly basis.

Detailed Description:

Depressive disorders affect 5-10% of older primary care patients, although rates may be higher among Latinos, especially among immigrants and those less acculturated. Late-life depression may be chronic and recurrent and results in significant morbidity and mortality. Despite a growing evidence base for the treatment of geriatric depression, only half of depressed older adults receive mental health care; fewer than 10% receive specialty services. Treatment rates are even lower for low-income, ethnic minorities who may be more ill and disabled, may lack adequate insurance and have different treatment preferences, and who frequently face barriers to accessing care. Recent quality improvement interventions for geriatric depression have targeted primary care, the location where older patients and ethnic minorities are most likely to receive mental health services. A recent multi-site, randomized trial of collaborative care for geriatric depression in primary care offered patients their choice of treatments, including antidepressant medication or 6-8 sessions of a structured psychotherapy. Although the intervention had few cultural accommodations, both processes and outcomes of care improved for depressed older minorities. However, because the study only included Latinos who were English-speaking and mostly high school graduates, these results may not generalize to a large proportion of ethnic minorities.

This study first examines current rates of depression and patterns of depression treatment in a public-sector geriatric clinic that serves mostly Spanish-speaking Latinos. Then depressed patients are identified and their depression treatment preferences and barriers to care are assessed. Patients are enrolled in a 6-month patient-centered, evidence-based intervention, and they, family members, and clinic medical providers are interviewed at program end to assess the feasibility, acceptability, and possible effectiveness of the intervention.

  Eligibility

Ages Eligible for Study:   60 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients of the LAC+USC Medical Center Geriatric Clinic
  • English- or Spanish-speaking
  • Positive for depression on the Geriatric Depression Scale
  • Current major depressive disorder or dysthymia
  • All adult family members, especially caregivers, and all regular clinic providers eligible for interviews

Exclusion Criteria:

  • History of bipolar disorder or psychosis
  • Significant cognitive impairment (score less than 24 on the Mini-Mental Status Examination, adjusted for age and education)
  • Acute suicidal ideation
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00570427

Locations
United States, California
LAC+USC Medical Center Geriatric Clinic
Los Angeles, California, United States, 90033
Sponsors and Collaborators
UCLA Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME)
Investigators
Principal Investigator: Isabel T. Lagomasino, MD MSHS Department of Psychiatry, Keck School of Medicine, University of Southern California
  More Information

Publications:
Responsible Party: Isabel T. Lagomasino, MD MSHS, Keck School of Medicine, University of Southern California
ClinicalTrials.gov Identifier: NCT00570427     History of Changes
Other Study ID Numbers: AG0091, 5P30 AG021684, 1557 G GD102
Study First Received: December 7, 2007
Last Updated: February 24, 2009
Health Authority: United States: Federal Government

Keywords provided by National Institute on Aging (NIA):
psychotherapy
behavior therapy
counseling
aging
medically underserved population

Additional relevant MeSH terms:
Depression
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders

ClinicalTrials.gov processed this record on April 17, 2014