Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Since older adults in community long-term care (CLTC) suffer disproportionately high levels of depression (Morrow-Howell, et al., 2002), this project used an innovative methodology of assessing stakeholder preferences to inform the implementation of evidence-based depression treatments into CLTC service agencies. Publicly-sponsored CLTC acts as a safety net by assisting low income people with chronic conditions compensate for functional disabilities by providing a wide range of in-home services and case management. The President's New Freedom Commission Report on Mental Health (2003) recommends that public agencies whose clients have unmet mental health care needs, such as CLTC, are potential sites for the integration of mental health care. Therefore, this study, which parallels the report by Lawrence and colleagues (2006) that older adults' beliefs about depression follow a culturally-influenced social model, examines CLTC clients' beliefs about depression to inform their engagement in mental health care in the non-mental health service sector of public CLTC services. Methods: This study involves in-depth mixed-method interviews with 50 participants as a follow-up to a previous clinical epidemiological study (Morrow-Howell, Proctor, Hasche, et al., 2002). All subjects were above the age of 60, had received public CLTC services during the initial study, and had subthreshold depressive symptoms during the initial study. For analysis, five members of the research team identified and labeled potential themes and developed coding categories using NVivo data-analysis software. Results: The sample was predominantly female. African Americans are over-represented due to the low-income, urban client population. The participants had a mild to moderate depression (Patient Health Questionnaire, mean: 10.41, SD = 5.12). Participants generally acknowledge depression and seem interested in help; however, they do not view depression as one of their most pressing problems. Two primary themes emerged. First, both Caucasian and African American older adult CLTC clients voiced conceptualizations consistent with a social model of depression (interrelationship with physical health, social support, physical functioning, and pain). Second, participants believed that addressing depression would impact other problem areas and, likewise, that addressing other problem areas would alleviate depression. Three themes regarding help-seeking were common: 1) frequent use of social avenues of help from friends, family, and religion; 2) desire for social contact influences treatment preferences; and 3) previous experiences with providers are generally negative and influence current help-seeking behaviors. Implications: Understanding conceptualizations of depression informs the transportation of evidence-based interventions into CLTC and the process of assessing treatment receptivity. These findings indicate that depression treatment should be linked to other services—both conceptually and practically.