Depression is a public health threat to older adults. It increases the risks of detrimental outcomes such as disability, mortality and institutionalization. 10% of older adults receiving home delivered meal service suffers from clinically significant depression. The majority of depressed elderly who are referred for mental health services do not successfully access care. Beyond the practical barriers of transportation and cost, they face psychological barriers, such as stigma and beliefs about depression and its care.
The aim of this application is to test the effectiveness of the Treatment Initiation Program (TIP), a brief psychosocial intervention to address the psychological barriers to care and improve the use of mental health services by depressed community elderly. The intervention is designed to help the older adult identify the barriers, problem-solve to find solutions and mobilize the motivation to seek help. TIP was developed to work collaboratively with an older adult who is depressed to improve access and adherence to mental health treatment. In prior research TIP has been found to improve treatment participation, reduce depressive symptoms and increase adherence to antidepressant therapy among depressed older adults in primary care and outpatient psychiatric settings. We propose to conduct a randomized controlled trial to determine the impact of TIP on access to care, defined as engagement, among depressed community dwelling older adults participating in a home delivered meal program. Consenting older adults (N=160) who are receiving home delivered meals and are screened as depressed (PHQ-9>9), will be randomized to either the Treatment Initiation Program (TIP) or the Referral control condition, a mental health referral with transportation arrangements. The goal of the research is to evaluate the impact of each condition on mental health treatment engagement (defined as attending two recommended mental health visits) and depressive symptoms over the following six months. In the proposed study subjects will be followed for 6 months and assessed 12 and 24 weeks after baseline assessment. If TIP is demonstrated to be effective, it has a high likelihood of being sustained by our community partners, the Westchester County Department of Senior Programs and Services.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH079265-03
Application #
7640949
Study Section
Mental Health Services in MH Specialty Settings (SRSP)
Program Officer
Azrin, Susan
Project Start
2007-09-05
Project End
2012-05-31
Budget Start
2009-06-01
Budget End
2010-05-31
Support Year
3
Fiscal Year
2009
Total Cost
$279,450
Indirect Cost
Name
Weill Medical College of Cornell University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
060217502
City
New York
State
NY
Country
United States
Zip Code
10065
Sirey, Jo Anne; Banerjee, Samprit; Marino, Patricia et al. (2016) Improving Mental Health Treatment Initiation among Depressed Community Dwelling Older Adults. Am J Geriatr Psychiatry 24:310-9
Greenfield, A P; Banerjee, S; Depasquale, A et al. (2016) Factors Associated With Nutritional Risk Among Homebound Older Adults With Depressive Symptoms. J Frailty Aging 5:149-157
Sirey, Jo Anne; Franklin, Anderson J; McKenzie, Sharon E et al. (2014) Race, stigma, and mental health referrals among clients of aging services who screened positive for depression. Psychiatr Serv 65:537-40
Sirey, Jo Anne; Greenfield, Alexandra; Weinberger, Mark I et al. (2013) Medication beliefs and self-reported adherence among community-dwelling older adults. Clin Ther 35:153-60
Sirey, Jo Anne; Greenfield, Alexandra; DePasquale, Alyssa et al. (2013) Improving engagement in mental health treatment for home meal recipients with depression. Clin Interv Aging 8:1305-12
Arean, Patricia A; Raue, Patrick J; Sirey, Jo Anne et al. (2012) Implementing evidence-based psychotherapies in settings serving older adults: challenges and solutions. Psychiatr Serv 63:605-7
Sirey, Jo Anne; Hannon, Charles P; D'Angelo, Debra et al. (2012) A community treatment intervention advancing active treatment in the elderly (ACTIVATE): a pilot study. J Gerontol Soc Work 55:382-91
Raue, Patrick J; Sirey, Jo Anne (2011) Designing personalized treatment engagement interventions for depressed older adults. Psychiatr Clin North Am 34:489-500, x
Sirey, Jo Anne; Bruce, Martha L; Carpenter, Mae et al. (2008) Depressive symptoms and suicidal ideation among older adults receiving home delivered meals. Int J Geriatr Psychiatry 23:1306-11