Johns Hopkins University, 525 Wolf Street, Baltimore, Maryland 21205, United States of America.
BMC Geriatr. 2012 Feb 10;12:4. doi: 10.1186/1471-2318-12-4.
Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness.
METHODS/DESIGN: Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55+ years old. It involves a collaboration with a senior center whose care management staff screen for depressive symptoms (telephone or in-person) using the Patient Health Questionnaire (PHQ-9). Individuals screened positive (PHQ-9 ≥ 5) on two separate occasions over 2 weeks are referred to local mental health resources and BTB. Interested and eligible participants who consent receive a baseline home interview and then are randomly assigned to receive BTB immediately or 4 months later (wait-list control). All participants are interviewed at 4 (main study endpoint) and 8 months at home by assessors masked to study assignment. Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs, make referrals/linkages, provide depression education, instruct in stress reduction techniques, and use behavioral activation to identify goals and steps to achieve them. Key outcomes include reduced depressive symptoms (primary), reduced anxiety and functional disability, improved quality of life, and enhanced depression knowledge and behavioral activation (secondary). Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions. Cost and cost effectiveness is being evaluated.
BTB is designed to bridge gaps in mental health service access and treatments for older African Americans. Treatment components are tailored to specific care needs, depression knowledge, preference for stress reduction techniques, and personal activity goals. Total costs are $584.64/4 months; or $146.16 per participant/per month.
ClinicalTrials.gov #NCT00511680.
初级保健是治疗抑郁症的主要场所；然而，美国许多年长的非裔美国人并未报告抑郁症状或接受推荐的标准护理。由于慢性疾病、残疾和社会经济困境的高发率，年长的非裔美国人患抑郁症的风险很高。迫切需要开发和测试新的、与少数民族共鸣的抑郁症治疗方法，这些少数民族难以接触和服务不足，并评估其成本和成本效益。
方法/设计：“战胜忧郁”（BTB）是一项单盲平行随机试验，旨在评估一种非药物干预措施对 208 名 55 岁以上非裔美国人减少抑郁症状和改善生活质量的疗效。它涉及与一家高级中心合作，该中心的护理管理人员使用患者健康问卷（PHQ-9）通过电话或面对面方式筛查抑郁症状。在两周内两次单独筛查 PHQ-9 得分≥5 的个体被转介到当地心理健康资源和 BTB。有兴趣且符合条件的参与者在同意后接受基线家庭访谈，然后随机分配立即接受 BTB 或 4 个月后（等待名单对照）。所有参与者在 4 个月（主要研究终点）和 8 个月在家中由对研究分配不知情的评估人员进行访谈。经过 BTB 培训的持照高级中心社会工作人员在家中与参与者会面，在 4 个月内进行多达 10 次会议，以评估护理需求、转介/联系、提供抑郁教育、指导减压技术，并使用行为激活来确定目标和实现目标的步骤。主要结果包括抑郁症状减轻（主要）、焦虑和功能障碍减轻、生活质量提高以及抑郁知识和行为激活增强（次要）。通过程序手册和员工培训来提高保真度，并通过面对面监督和审查录音会议进行监测。正在评估成本和成本效益。
BTB 旨在弥合老年非裔美国人获得心理健康服务和治疗方面的差距。治疗内容针对特定的护理需求、抑郁知识、减压技术偏好和个人活动目标进行了定制。总费用为 584.64 美元/4 个月；或每位参与者每月 146.16 美元。
ClinicalTrials.gov #NCT00511680。
