Improving Depression Treatment for Older Minority Adults

Depression Clinical Trial

Official title:

Improving Depression Treatment for Older Minority Adults

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00570427
• Other study ID #: AG0091
• Secondary ID: 5P30AG0216841557
• Status: Completed
• Phase: N/A
• First received: December 7, 2007
• Last updated: February 24, 2009
• Start date: February 2007
• Est. completion date: June 2008

Study information

• Verified date: February 2009
• Source: National Institute on Aging (NIA)
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Federal Government
• Study type: Interventional

Clinical Trial Summary

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

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 30
• Est. completion date: June 2008
• Est. primary completion date: June 2008
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 60 Years and older

Eligibility

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

Study Design

Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Depression
• Depressive Disorder

Intervention

Behavioral:
• Problem Solving Therapy (PST)
Counseling
• 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.

Locations

Country	Name	City	State
United States	LAC+USC Medical Center Geriatric Clinic	Los Angeles	California

Sponsors (2)

Lead Sponsor	Collaborator
National Institute on Aging (NIA)	University of California, Los Angeles

Country where clinical trial is conducted

United States, 

References & Publications (3)

Dwight-Johnson M, Lagomasino IT. Addressing depression treatment preferences of ethnic minority patients. Gen Hosp Psychiatry. 2007 May-Jun;29(3):179-81. — View Citation

Lagomasino IT, Dwight-Johnson M, Miranda J, Zhang L, Liao D, Duan N, Wells KB. Disparities in depression treatment for Latinos and site of care. Psychiatr Serv. 2005 Dec;56(12):1517-23. — View Citation

Vega WA, Karno M, Alegria M, Alvidrez J, Bernal G, Escamilla M, Escobar J, Guarnaccia P, Jenkins J, Kopelowicz A, Lagomasino IT, Lewis-Fernandez R, Marin H, Lopez S, Loue S. Research issues for improving treatment of U.S. Hispanics with persistent mental disorders. Psychiatr Serv. 2007 Mar;58(3):385-94. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Depression severity, depression treatment preferences, and barriers to care		baseline and 6 months	No
Secondary	Feasibility, acceptability, and effectiveness of intervention		6 months	No