Because older men are more likely than older women to be under-treated for depression and to commit suicide, more effective strategies are needed to engage and treat depressed older men in primary care. One strategy to improve depression care for older men is to build upon existing patient relationships with family members or close friends. This approach builds on the well-documented health-related support that family members provide both in the home and in the clinic, even among relatively healthy or nondisabled older adults. Yet the support that families provide for healthcare is often not well-integrated with professionally-delivered care in primary care settings. Family-based interventions to improve self-management for other chronic health conditions (e.g. diabetes) have been successfully developed but there is a striking lack of primary-care based intervention studies that incorporate family members as an integral part of depression treatment. From a public health perspective, there are compelling reasons to do so. Family involvement may reduce barriers to care, such as the patient's reluctance to disclose depressive symptoms, stigma or treatment nonadherence. Overcoming these barriers may be particularly important to close gaps in care for under-served subgroups of older adults, such as older men and minorities. Strengthening depression treatment in primary care settings by building on existing family relationships aligns with the preferences of older men and may be both cost effective and enduring. In this R-34 application, we will develop and test the feasibility and acceptability of a family-based intervention in a community-based primary care clinic serving a predominantly low-income and minority older adult population with high rates of untreated or undertreated depression. Our approach to intervention development is theory-driven and uses Wagner's chronic care model as an over-arching framework. It also draws on several other theoretical frameworks (e.g. self-efficacy, social control, relational coordination) to specify potential mechanisms through which family members may strengthen depression care.
Specific aims of this project are 1) To conduct and analyze in-depth 36 interviews with key stakeholders in older men's depression care, including older men, potential family/friend helpers and clinic staff, 2) Informed by Aim 1 and our preliminary studies, to refine the intervention approach and to develop the intervention protocol (e.g. treatment and implementation manuals) and 3) To test the feasibility and acceptability of the intervention and study methods in a pilot randomized controlled trial of 24 depressed older men drawn from the target population.
Despite the public health importance of clinical depression, more than 50% of depressed adults receive inadequate or no treatment, with even higher rates of under-treatment in men and minorities. Family members and/or friends often assist older adults in their health care and may help overcome barriers to formal care, yet there is a lack of primary care-based interventions that mobilize family members and friends to improve depression treatment. In partnership with a community-based clinic, this research will address this scientific gap by developing and then testing the feasibility and acceptability of a family-based intervention that can be delivered pragmatically in a primary care setting serving large numbers of older minorities.
|Hinton, Ladson; Apesoa-Varano, Ester Carolina; Unützer, Jürgen et al. (2015) A descriptive qualitative study of the roles of family members in older men's depression treatment from the perspectives of older men and primary care providers. Int J Geriatr Psychiatry 30:514-22|