Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: This study examined racial/ethnic differences in older adults' attitudes toward psychological and pharmacological treatments for depression. Focus was on perceptions about acceptability, suitability, effectiveness, and risks/discomforts of four different treatment modalities that have been effective with older adults. Although research on older adults' acceptance of psychological and pharmacological treatments for depression has been done, possible racial/ethnic difference has not been examined. Methods: Structured interviews with 206 older adults aged 60 and older in low-income neighborhoods of a large Texas city were conducted in 2005. Thirty-five percent of the participants were non-Hispanic white, 36% were African American, and 29% were Hispanic. We assigned each study participant randomly to one of 8 vignette-conditions (2 levels of severity x 4 treatment modality descriptions). Each condition included between 22 and 31 participants. No significant difference in sociodemographic, health, and mental health statuses was found among 8 vignette-condition groups. Each case vignette included a 75-year old woman suffering from symptoms of middle-to-moderate depression or severe depression. Four treatment modalities were clinic-based cognitive therapy (CT); in-home cognitive bibliotherapy (CB); antidepressant medication (AM); and physical exercise intervention (PE). Both case vignettes and all treatment descriptions except PE have been validated in previous studies. The author wrote the PE description based on previous study findings of PE as an effective depression intervention for older adults. Treatment acceptability, effectiveness, and risks/discomforts were measured by the 11-item Treatment Evaluation Inventory (TEI: Kadzin, 1980; Landreville& Guerette, 1998). Higher TEI scores mean more positive attitudes toward the treatment. Cronbach's alpha for the TEI was sufficiently high at 0.901. Results: One-way ANOVA results show no racial/ethnic differences in TEI scores. Regardless of race/ethnicity, AM was rated significantly lower than CT (48.9 [SD=13.8] vs. 59.0 [SD=10.5], p<.05) for mild-to-moderate level of depression only. Risks and discomforts due to possible medication side effects were rated high. Results of the OLS regression analysis showed that AM, as compared to CT, was significantly associated with lower TEI scores for mild-to-moderate depression, while CB, as compared to CT, was significantly associated with lower TEI scores for severe depression, controlling for sociodemographic characteristics, and health and mental health status. For mild-to-moderate depression, being African Americans, as opposed to non-Hispanic whites, was significantly positively associated with higher TEI scores, whereas the level of income and homebound status of participants, as opposed to ambulatory status, were inversely associated with TEI scores. For severe depression, higher level of social support and female gender predicted significantly higher TEI scores, while higher level of education predicted significantly lower TEI scores. For both severity levels, participants' scores on the Geriatric Depression Scale and previous history of professional mental health treatment were not significantly associated with TEI scores. Implications: Regardless of race/ethnicity, older adults have positive attitudes toward psychological treatments for depression. For mild-to-moderate level of depression, they prefer clinic-based CT to antidepressant medication. Systemic and financial barriers, rather than attitudinal barriers, to accessing psychological interventions for depression in late life appear to be problems resulting in underutilization of mental health services among older adults.