23 August 2013

Home therapy helps depressed older African Americans

According to a study, bringing help to depressed, older African Americans in their homes was modestly effective.


Bringing treatment and other help to depressed, middle-aged and older African Americans in their homes was modestly effective in a new study.

After four months of weekly one-hour sessions with a trained social worker, participants scored lower on a scale measuring symptoms of depression, compared to those who didn't get the home visits."Our focus was very much to help people address their immediate concerns and anxieties and become engaged in activities that are important to them," Laura Gitlin, the study's lead author, told Reuters Health.

"For the treatment group compared to the control group they benefited significantly more," Gitlin, who is director of the Center for Innovative Care in Aging at Johns Hopkins University School of Nursing in Baltimore, said.

Beat the Blues

The programme, known as Beat the Blues, consists of regular one-hour sessions in which participants are taught about depression, coping methods and stress reduction techniques, and assessed to see if they have unmet medical or social service needs.

The social workers helped participants with their external problems – for instance, by linking them with social and medical services. They also coached participants in identifying goals for activities that could help improve their mood, such as making family meals, getting regular exercise, travelling or taking classes, and helped participants create an action plan to accomplish their goals.

Previous research has found that up to 30% of older African Americans experience symptoms of depression. This same group is also at increased risk of not receiving treatment, because they either lack access to care or for cultural reasons they are not inclined to seek it, researchers said. "Depression still remains a stigmatised form of disease that people consider a natural part of ageing and something that you should overcome yourself," Gitlin said.

"Working in the home is really destigmatising and allows people to talk." For the new study, the researchers recruited 208 African Americans aged 55 and older to complete four months or 10 sessions of Beat the Blues between 2008 and 2010. On a test that measures depressive symptoms, all of the participants scored at least a 5 on a scale of 0 to 27, with higher numbers representing more severe depression.

Researchers then randomly assigned half of the participants to a group that received the treatments, while the other half was put on a waiting list for the programme.

Modest improvement

At the beginning of the study, people participating in the sessions had an average depression score of 13.3, which represents moderately severe depression. At the end, their average score fell to about 6.4.That compared to the wait-listed group, which began the study with a severity score of 12.7 and ended it with a score of 8.9.

"They showed some modest improvement in depressive scores," Joel Sneed, an assistant professor in the Department of Psychiatry at Columbia University in New York, told Reuters Health.

While the difference between the two groups may seem small, the researchers write in the Annals of Internal Medicine that there were other noticeable differences.

For example, 64% of programme participants showed improvements at the end of their four months, compared to about 41% of waitlisted participants.

People who took part in the programme also maintained those benefits after eight months. Sneed, who was not involved in the new study, said it "shows something is better than nothing". "Something like home-based interventions may be a treatment of choice for someone who is quite sceptical about receiving help from the medical community," he added.

Gitlin said she thinks Beat the Blues can be used in communities now because its components have been tested in other studies. "I think it's ready for dissemination specifically for this group. I also think it has great relevance for any disenfranchised group. That includes Latinos and any low-income individuals," she said, adding that they also have a study examining the programme's cost awaiting publication.


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Depression expert

Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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