Reducing Disparities in Late Life Depression and Metabolic Syndrome - Full Text View

Purpose

Linkages between depression and cardiovascular disease have been well documented. These appear to be more than associations, and may reflect causal relationships through a number of proposed pathways, including decreased physical activity, poor dietary habits, medication non-adherence, and a direct impact on inflammatory mediators. Older adults are affected by both depression and heart disease, with increased risk in African American and Latino elderly.

The BRIGHTEN-Heart trial tests the hypothesis that an enhanced primary care delivery system intervention which provides evidence-based, patient-centered mental health services targeting depression and cardiovascular risk factors can reduce the risk of development of cardiovascular disease in low-income elderly blacks and Hispanics. BRIGHTEN stands for Bridging Resources of a Geriatric Health Team via Electronic Networking, and in this intervention, specialty providers including geropsychologists, social workers, pharmacists, nutritionists, chaplains, occupational therapists, and others collaborate via the internet as a virtual team. The study will determine if such a virtual interdisciplinary clinical team collaboration can reduce depression in older (age ≥ 65) minority adults with comorbid depression and metabolic syndrome.

Condition	Intervention
Depressive Symptoms Metabolic Syndrome X Overweight Obesity Hypertension Hyperglycemia Dyslipidemias	Behavioral: Generations older adult membership program Behavioral: BRIGHTEN Heart Virtual Team intervention

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Outcomes Assessor) Primary Purpose: Treatment
Official Title:	BRIGHTEN Heart: Reducing Disparities in Late Life Depression and Metabolic Syndrome

Resource links provided by NLM:

MedlinePlus related topics: Depression High Blood Pressure Hyperglycemia Mental Health Metabolic Syndrome Obesity

U.S. FDA Resources

Further study details as provided by Rush University Medical Center:

Primary Outcome Measures:

Clinical Depression Scores, as measured by PHQ-9 [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]
Depression has been shown to double both the risk of developing heart disease and mortality risk for persons who do develop heart disease. The Primary Aim of the trial is to document reduction in symptoms of depression in persons receiving the intervention, relative to the control group. The PHQ-9 instrument is the most widely used symptom measure of depression, and has been validated across multiple populations, and in a Spanish-translation as well

Secondary Outcome Measures:

Cardiometabolic risk factors [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Risk for the development of heart disease will be compared via clinical measures and blood tests. Clinical measurements include Blood Pressure, Weight, and Waist Circumference. Blood tests include Hemoglobin A1c, HDL Cholesterol, LDL Cholesterol, and hsCRP.

Estimated Enrollment:	250
Study Start Date:	March 2011
Estimated Study Completion Date:	December 2015
Estimated Primary Completion Date:	March 2015 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Generations older adult membership program Rush Generations is a membership program for older adults, providing chronic disease prevention and management through educational programming, civic engagement, and individual and family consultations with social work staff.	Behavioral: Generations older adult membership program Rush Generations is a membership program for older adults emphasizing chronic disease prevention and management through a wide range of health and aging-related programs. Participants assigned to the Generations intervention are actively encouraged to participate in activities, including: RUSH-based lectures by experts in the fields of health and aging providing practical information and resources on physical and mental health, functional status, and social support. Twice per month. Individual and family consultations with social work staff. Health fairs with a variety of assessment services and information about community-based social service and health agencies. Twice per year. Assistance with referral to community programs such as physical activity, driver safety events, and mind-body connection workshops.
Experimental: BRIGHTEN Heart Virtual Team BRIGHTEN Heart provides older adults with an interdisciplinary team evaluation of physical and mental health and on-going support for mental health and health behavior change for a minimum of six months. The five core components of the BRIGHTEN intervention consist of: 1) Assessment; 2) Virtual team case review; 3) Patient centered action planning; 4) Plan implementation, and; 5) When indicated, short-term evidence-based geriatric specialty psychotherapy.	Behavioral: BRIGHTEN Heart Virtual Team intervention BRIGHTEN Heart provides an interdisciplinary team evaluation of physical and mental health and on-going support for mental health & health behavior change for 6 - 12 months, including: Comprehensive health risk assessment by a licensed social worker, including physical, mental, and functional status. Virtual team case review and recommendations by interdisciplinary team of health professionals including psychologist, social worker, occupational therapist, pharmacist, chaplain, dietitian, geriatric psychiatrist, and the patient's primary care physician. Development of Patient Centered Action Plan, in which the social worker assists the patient in prioritizing recommendations. Monthly telephone calls by the social worker to support implementation of Action Plan and to provide ongoing Case Management. Evidence Based Psychotherapy, as needed, delivered by supervised geriatric psychology and social work fellows. Duration determined by monthly assessments.

Arms

Assigned Interventions

Active Comparator: Generations older adult membership program

Rush Generations is a membership program for older adults, providing chronic disease prevention and management through educational programming, civic engagement, and individual and family consultations with social work staff.

Behavioral: Generations older adult membership program

Rush Generations is a membership program for older adults emphasizing chronic disease prevention and management through a wide range of health and aging-related programs. Participants assigned to the Generations intervention are actively encouraged to participate in activities, including:

RUSH-based lectures by experts in the fields of health and aging providing practical information and resources on physical and mental health, functional status, and social support. Twice per month.
Individual and family consultations with social work staff.
Health fairs with a variety of assessment services and information about community-based social service and health agencies. Twice per year.
Assistance with referral to community programs such as physical activity, driver safety events, and mind-body connection workshops.

Experimental: BRIGHTEN Heart Virtual Team

BRIGHTEN Heart provides older adults with an interdisciplinary team evaluation of physical and mental health and on-going support for mental health and health behavior change for a minimum of six months. The five core components of the BRIGHTEN intervention consist of: 1) Assessment; 2) Virtual team case review; 3) Patient centered action planning; 4) Plan implementation, and; 5) When indicated, short-term evidence-based geriatric specialty psychotherapy.

Behavioral: BRIGHTEN Heart Virtual Team intervention

BRIGHTEN Heart provides an interdisciplinary team evaluation of physical and mental health and on-going support for mental health & health behavior change for 6 - 12 months, including:

Comprehensive health risk assessment by a licensed social worker, including physical, mental, and functional status.
Virtual team case review and recommendations by interdisciplinary team of health professionals including psychologist, social worker, occupational therapist, pharmacist, chaplain, dietitian, geriatric psychiatrist, and the patient's primary care physician.
Development of Patient Centered Action Plan, in which the social worker assists the patient in prioritizing recommendations.
Monthly telephone calls by the social worker to support implementation of Action Plan and to provide ongoing Case Management.
Evidence Based Psychotherapy, as needed, delivered by supervised geriatric psychology and social work fellows. Duration determined by monthly assessments.

Show Detailed Description

Eligibility

Ages Eligible for Study:	60 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

At least 60 years of age.
Overweight or Obese as documented by BMI greater than 25.0.
Presence of Depression symptoms, as determined by having a PHQ-9 score of 8 or more.
Receiving primary care through a participating safety net clinic (public clinic or FQHC)

Exclusion Criteria:

Below the age of 60 years old at time of enrollment.
Lack decisional capacity (due to dementia, active psychosis, or other cause).
Are currently under active behavioral treatment of a psychologist or psychiatrist for any reason.
Lack regular access to a telephone in their home (including cell phone).
Are enrolled in another intervention trial

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01428791

Contacts

Contact: Steven K Rothschild, MD	312 942 3476	steven_k_rothschild@rush.edu
Contact: Erin Emery, PhD	312 942 6294	erin_emery@rush.edu

Locations

United States, Illinois
Cook County Health and Hospital System	Recruiting
Chicago, Illinois, United States
Resurrection Medical Center	Recruiting
Chicago, Illinois, United States

Sponsors and Collaborators

Rush University Medical Center

Investigators

Principal Investigator:	Steven K Rothschild, MD	Department of Preventive Medicine, Rush University Medical Center
Principal Investigator:	Erin Emery, PhD	Department of Behavioral Sciences, Rush University Medical Center

More Information

No publications provided

Responsible Party:	Steven K. Rothschild, MD, MD, Rush University Medical Center
ClinicalTrials.gov Identifier:	NCT01428791 History of Changes
Other Study ID Numbers:	1P50 HL105189-01
Study First Received:	September 1, 2011
Last Updated:	September 24, 2012
Health Authority:	United States: National Heart Lung and Blood Institute

Keywords provided by Rush University Medical Center:

Geriatrics
Older adults
Health Disparities
Health Services for the Aged
Interdisciplinary Health Team
Depressive symptoms

Metabolic Syndrome X
Overweight
Obesity
Hypertension
Hyperglycemia
Dyslipidemias

Additional relevant MeSH terms:

Depression
Depressive Disorder
Hyperglycemia
Hypertension
Obesity
Dyslipidemias
Overweight
Metabolic Syndrome X
Behavioral Symptoms
Mood Disorders
Mental Disorders

Glucose Metabolism Disorders
Metabolic Diseases
Vascular Diseases
Cardiovascular Diseases
Overnutrition
Nutrition Disorders
Body Weight
Signs and Symptoms
Lipid Metabolism Disorders
Insulin Resistance
Hyperinsulinism

ClinicalTrials.gov processed this record on May 23, 2013

Reducing Disparities in Late Life Depression and Metabolic Syndrome (BRIGHTEN-Heart)