Center for Innovative Care in Aging School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
Principal Faculty, Center for Innovative Care in Aging, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Int J Geriatr Psychiatry. 2018 Jan;33(1):e31-e39. doi: 10.1002/gps.4710. Epub 2017 Apr 12.
Previously, we showed that Get Busy Get Better (GBGB), a 10-session multicomponent home-based, behavioral intervention, reduced depressive symptom severity in older African Americans. As appraising the value of life is associated with depressive symptoms, this study examined whether GBGB enhanced positive appraisals of life and if, in turn, this mediated treatment effects on depressive symptoms.
Data were from a single-blind parallel randomized trial involving 208 African Americans (≥55 years old) with depressive symptoms (Patient Health Questionnaire, PHQ-9 ≥5). GBGB involved five components: care management, referral/linkage, stress reduction, depression education, and behavioral activation. A 13-item Valuation of Life (VOL) scale with two subfactors (optimism and engagement) was examined as an outcome and as mediating GBGB effects on PHQ-9 scores at 4 months.
Of 208 enrolled African Americans, 180 completed the 4-month interview (87 = GBGB; 93 = control). At 4 months, compared with wait-list control group participants, the GBGB group had improved VOL (difference in mean changes from baseline = 4.67, 95% confidence interval 2.53, 6.80). Structural equation models indicated that enhanced VOL mediated a significant proportion of GBGB's impact on depressive symptoms, explaining 71% of its total effect, and its subfactors (optimism, explaining 67%; engagement, 52%).
Valuation of Life appears malleable through an intervention providing resources and activation skills. GBGB's impact on depressive symptoms is attributed in large part to participants' enhanced attachment to life. Attention to VOL as mediator and outcome and the reciprocal relationship between mood and attachment to life is warranted. Copyright © 2017 John Wiley & Sons, Ltd.
此前，我们发现一种为期 10 次的、基于家庭的、多成分的行为干预措施“忙碌起来，变得更好”（Get Busy Get Better，GBGB）可降低老年非裔美国人的抑郁症状严重程度。因为对生活的评价与抑郁症状有关，因此本研究检验了 GBGB 是否增强了对生活的积极评价，以及这种积极评价是否反过来介导了治疗对抑郁症状的影响。
数据来自一项单盲平行随机试验，涉及 208 名有抑郁症状（患者健康问卷，PHQ-9≥5）的非裔美国人（≥55 岁）。GBGB 包含五个组成部分：关怀管理、转介/联系、减轻压力、抑郁教育和行为激活。采用 13 项生活价值观量表（VAL）及其两个亚因素（乐观和投入）作为结果，并检验其在 4 个月时对 PHQ-9 评分的中介作用。
在 208 名入组的非裔美国人中，有 180 人完成了 4 个月的访谈（87 人=GBGB；93 人=对照组）。与等待名单对照组相比，GBGB 组在 4 个月时的 VAL 评分有所改善（从基线到随访的平均变化差异=4.67，95%置信区间 2.53，6.80）。结构方程模型表明，VAL 的增强部分解释了 GBGB 对抑郁症状的影响，占其总效应的 71%，其亚因素（乐观，占 67%；投入，占 52%）。
通过提供资源和激活技能的干预措施，生活价值观似乎可以改变。GBGB 对抑郁症状的影响在很大程度上归因于参与者对生活的依恋增强。关注 VAL 作为中介和结果，以及情绪和对生活的依恋之间的相互关系是合理的。
