Home-based intervention reduces depressive symptoms in older African Americans

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1. In African American patients aged >55 years old, implementation of a multifaceted home-based care intervention was associated with decreased depression symptom severity compared to controls at 4 months.  These benefits were maintained for at least 8 months. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown:  In the elderly, depression is widespread and devastating.  This is especially true in an African American subset, as this group is often underserved at the level of the healthcare system.  Among many reasons, a major impediment is the stigma to receive treatment.  Senior centers which typically do not offer depression care may be able to fill this gap in the system.  This study looked at the role in-home treatment sessions could play in depressive symptoms.  Patients were randomized to receive an intervention involving a 10 session, home based, multi-component program delivered by a social worker or to a waitlist.   It was found that participants in the intervention arm showed reduced depression severity at 4 months.  This effect was seen until 8 months at which time the study was concluded.  After 4 months, control participants were switched to the intervention arm and showed a similar effect to treatment, which strengthened the study.  The major weakness of this study is the small sample size (208)  as well as the short duration (8 months).  Despite this, these results are critical as they study an underserved population and provide a result that may decrease a common cause of morbidity in the elderly.

Click to read the study, published today in the Annals of Internal Medicine 

Relevant Reading: Symptoms of Depression Among Community-dwelling elderly African-American and White older adults

In-Depth [Randomized single control trial]: This study enrolled 208 participants, retaining 182 (89 intervention and 93 control) and 160 (79 intervention and 81 control) at 4 mo. and 8 mo respectively.  The intervention arm included 10 1-hour in-home, weekly sessions for 4 months with subsequent biweekly sessions after 4 months.  These interventions included assessment of unmet needs, linkage to resources, education, and stress reduction techniques.  In the control arm, patients did not receive any study based-intervention.  The primary outcome was severity of depressive symptoms, which was assessed using the PHQ-9 scale (a brief, psychometrically valid 9-item self-report measure).  At 4 months, pts had a difference in their PHQ-9 scores of -2.9 (95% CI,-4.6 to -1.2].  Secondary outcomes included significantly improved depression knowledge, quality of life, behavior activation and anxiety (P<0.001). These results were maintained for at least 8 months.

By Adam Whittington and Aimee Li, MD

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