Original Research
20 August 2013

A Home-Based Intervention to Reduce Depressive Symptoms and Improve Quality of Life in Older African Americans: A Randomized Trial

Publication: Annals of Internal Medicine
Volume 159, Number 4

Abstract

Background:

Effective care models for treating older African Americans with depressive symptoms are needed.

Objective:

To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.

Design:

Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680)

Setting:

A senior center and participants' homes from 2008 to 2010.

Patients:

African Americans aged 55 years or older with depressive symptoms.

Intervention:

A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months.

Measurements:

Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months.

Results:

Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, −2.9 [95% CI, −4.6 to −1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, −3.7 [CI, −5.4 to −2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months.

Limitation:

The study had a small sample, short duration, and differential withdrawal rate.

Conclusion:

A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans.

Primary Funding Source:

National Institute of Mental Health.

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 159Number 420 August 2013
Pages: 243 - 252

History

Published online: 20 August 2013
Published in issue: 20 August 2013

Keywords

Authors

Affiliations

Laura N. Gitlin, PhD
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Lynn Fields Harris, MPA
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Megan C. McCoy, MSS, MLSP
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Nancy L. Chernett, MPH
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Laura T. Pizzi, PharmD, MPH
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Eric Jutkowitz, BA
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Edward Hess, MS
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Walter W. Hauck, PhD
From Johns Hopkins University, Baltimore, Maryland; Center in the Park and Thomas Jefferson University, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; and Sycamore Consulting, New Hope, Pennsylvania.
Note: The principal investigator (Dr. Gitlin) had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Acknowledgment: The authors thank the research staff, including interviewers, interventionists, and care managers, and the study participants for their contributions to the study.
Financial Support: By the National Institute of Mental Health (R01MH079814).
Reproducible Research Statement: Study protocol and statistical code: Not available. Data set: Available from Dr. Gitlin (e-mail, [email protected]).
Corresponding Author: Laura N. Gitlin, PhD, Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 Wolfe Street, Suite 316, Baltimore, MD 21205; e-mail, [email protected].
Current Author Addresses: Dr. Gitlin: Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 Wolfe Street, Suite 316, Baltimore, MD 21205.
Ms. Fields Harris and Ms. McCoy: Center in the Park, 5818 Germantown Avenue, Philadelphia, PA 19144.
Ms. Chernett: Jefferson School of Population Health, Thomas Jefferson University, 1015 Walnut Street, Suite 115, Philadelphia, PA 19107.
Dr. Pizzi: Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, 130 South 9th Street, Suite 1540, Philadelphia, PA 19107.
Mr. Jutkowitz: University of Minnesota, Health Policy and Management, 420 Delaware Street SE, MMC 729, Minneapolis, MN 55455.
Mr. Hess: University Hospital, 13611 East Colfax Avenue, Aurora, CO 80045.
Dr. Hauck: Sycamore Consulting, 5992 Pidcock Creek Road, New Hope, PA 18938.
Author Contributions: Conception and design: L.N. Gitlin, L. Fields Harris, N.L. Chernett, W.W. Hauck.
Analysis and interpretation of the data: L.N. Gitlin, W.W. Hauck, E. Hess.
Drafting of the article: L.N. Gitlin, W.W. Hauck, E. Hess.
Critical revision of the article for important intellectual content: L.N. Gitlin, L. Fields Harris, L.T. Pizzi, E. Hess.
Final approval of the article: L.N. Gitlin, L. Fields Harris, M.C. McCoy, N.L. Chernett, L.T. Pizzi, E. Jutkowitz, E. Hess.
Provision of study materials or patients: L.N. Gitlin.
Statistical expertise: E. Hess, W.W. Hauck.
Obtaining of funding: L.N. Gitlin.
Administrative, technical, or logistic support: L.N. Gitlin, L. Fields Harris, N.L. Chernett, L.T. Pizzi, E. Jutkowitz.
Collection and assembly of data: L.N. Gitlin, M.C. McCoy, N.L. Chernett, E. Hess.

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Laura N. Gitlin, Lynn Fields Harris, Megan C. McCoy, et al. A Home-Based Intervention to Reduce Depressive Symptoms and Improve Quality of Life in Older African Americans: A Randomized Trial. Ann Intern Med.2013;159:243-252. [Epub 20 August 2013]. doi:10.7326/0003-4819-159-4-201308200-00005

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