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增加抑郁症治疗方法:对脆弱老年人进行同伴支持的随机对照试验的方法和挑战。

Increasing the Repertoire for Depression Care: Methods and Challenges of a Randomized Controlled Trial of Peer Support for Vulnerable Older Adults.

机构信息

Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

出版信息

Am J Geriatr Psychiatry. 2023 Aug;31(8):586-595. doi: 10.1016/j.jagp.2023.01.023. Epub 2023 Feb 2.

Abstract

OBJECTIVE

Low-income White and older adults of color face barriers to depression care. Our purpose is to describe the methods and challenges encountered during the implementation of a randomized controlled trial to test the effectiveness of a peer support depression care intervention for low-income White and older adults of color during the COVID-19 pandemic.

METHODS

Peer Enhanced Depression Care (Peers) is an 8-week community-based intervention that uses peer mentors who are trained and supervised to provide social support and self-care skills to depressed older adults. The effectiveness of the intervention in reducing depression will be evaluated by following a sample of older adults recruited in the community over a 12-month period. Target enrollment is 160 older adults. We hypothesize that participants randomized to the Peer Enhanced Depression Care intervention will experience greater decrease in depressive symptoms compared to participants randomized to the social interaction control. We provide lessons learned regarding the recruitment of BIPOC and White low-income older adults and peer mentors during the COVID-19 pandemic.

RESULTS

Recruitment challenges occurred in primary care clinics that were unable to accommodate recruitment efforts during the pandemic. This led to focused outreach to community-based organizations serving older adults. Challenges to participant recruitment have included barriers related to stigma, distrust, as well as unfamiliarity with research. Peer mentor recruitment was facilitated by existing government-supported resources.

CONCLUSIONS

This study will provide knowledge regarding the effectiveness, mechanism, and processes of delivering an informal psychosocial intervention such as peer support to a vulnerable older adult population.

摘要

目的

收入较低的白人和老年有色人种面临着抑郁症治疗的障碍。我们的目的是描述在实施一项随机对照试验以测试针对 COVID-19 大流行期间的低收入白人和老年有色人种的同伴支持抑郁症护理干预措施的有效性时所遇到的方法和挑战。

方法

同伴增强型抑郁症护理(Peers)是一种基于社区的 8 周干预措施,它使用经过培训和监督的同伴导师为抑郁的老年人提供社会支持和自我保健技能。通过对在 12 个月期间在社区招募的老年成年人样本进行随访,评估干预措施在减轻抑郁方面的有效性。目标入组人数为 160 名老年人。我们假设,与随机分配到社交互动对照组的参与者相比,随机分配到同伴增强型抑郁症护理干预组的参与者的抑郁症状会有更大程度的减轻。我们提供了在 COVID-19 大流行期间招募 BIPOC 和白人低收入老年人和同伴导师方面的经验教训。

结果

在初级保健诊所中出现了招募挑战,这些诊所无法在大流行期间适应招募工作。这导致了对为老年人服务的社区组织的集中外联。参与者招募的挑战包括与污名、不信任以及对研究的不熟悉有关的障碍。同伴导师的招募得到了现有的政府支持资源的促进。

结论

这项研究将提供有关向弱势老年人群体提供非正式心理社会干预(如同伴支持)的有效性、机制和过程的知识。

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