Problem-Solving Therapy for Late-Life Depression in Home Care: A Randomized Controlled Trial
Zvi D. Gellis, PhD, State University of New York at Albany, Jean McGinty, MScN, State University of New York at Albany, Elizabeth Misener, PhD, State University of New York at Albany, and Steven Banks, PhD, State University of New York at Albany.
Purpose: Late life depression presents a special problem for older adults and practitioners in acute home care settings, where prevalence and impact are particularly high and often goes unscreened and untreated. Recognition may be most problematic for older adults who present with more somatic than psychological symptoms, and who experience co-occurring medical illnesses that complicate diagnosis. Given the negative consequences of depression, developing and testing psychosocial interventions to improve the quality of life of medically ill home care elderly and reduce their psychological distress is important. Authors present data from a pilot research program initiated to develop, refine, and test the outcomes of Brief Problem Solving Therapy in Home Care (PST-HC) that targets the needs of older adults with severe depressive symptoms. Methods: Using a randomized clinical trial design, we compared the impact of PST-HC to UHC (Usual Home Care) in a sample of 40 older medically ill home care patients with severe depressive symptoms at 6 and 12-weeks postbaseline. Participants were recruited through home care intake assessment screens from a large certified agency between January 2003 and May 2004. Primary inclusion criteria included 65 yrs or older, a score of ³22 on the CES-D depression screen and a score of ³24 on the MMSE, signed informed consent, and consider non-pharmacological treatment for depression. Exclusion criteria included acute suicidal behavior, diagnosis of psychosis, bipolar disorder, borderline personality disorder, or substance abuse within the past month. Six sessions of home-based PST-HC were provided to participants in the experimental condition. PST-HC was based on an empirically-validated intervention model developed for depression (Nezu, Nezu, & Perri, 1989). Participants in the UHC condition received usual home health care services and a primary care referral for medication. Participants in usual care also received literature on depression and its treatment, and reviewed the material with a social worker during a scheduled visit. Primary outcome variables were depressive symptoms and quality of life and secondary outcomes were problem-solving abilities and satisfaction with treatment. Data analyses included descriptive statistics and repeated measures multivariate analyses of variance. Results: Outcome data suggested significant improvements in depression symptomatology, quality of life, and perceived problem-solving abilities after PST-HC, relative to UHC. F-values representing the outcome variables were found to be significant at the .001 level for the main effects of both time and condition. The following consistent picture emerged regarding effects due to condition over time. Participants in the PST-HC condition improved significantly as compared with the UHC group on the outcome variables; they reported significantly lower levels of depressive symptoms, higher quality of life scores, higher scores on problem-solving ability, and higher satisfaction with treatment scores as compared to UHC. Implications: The data provide promising findings that may improve the care for older homebound adults with severe depressive symptoms. Authors discuss the findings in terms of the "real-world" applicability of this psychosocial intervention for late-life depression, and present implications for social work practice and research.