This study proposes to compare the efficacy of Case Management combined with Problem Solving Therapy (CM-PST) to that of Case Management alone (CM) in low-income elderly recipients of Home-Delivered Meals Services with major depression, disability and problem solving difficulties. We focus on meals recipients because they are often afflicted by depression and because the complexity of their clinical state coupled with their financial limitations creates a formidable challenge for care. Clinical logic and emerging empirical data suggest that integrating CM with PST may have a synergistic effect in depressed low-income elders as CM can help them with their socioeconomic needs and PST can improve their ability to cope with chronic stressors and utilize their new resources. The participants will be 200 (100 from each Center) elderly (>64 years) non-psychotic, non-demented Home-Delivered Meals recipients with unipolar major depression who will be randomly assigned to receive 12 sessions of CM-PST or CM. The study is designed to test the hypotheses that CM-PST is more effective than CM in reducing depressive symptoms and disability;both treatments will be delivered at the clients'homes by trained case workers of the Home-Delivered Meals Services. Furthermore, we hypothesize that these effects are mediated by improvement in generation of alternative solutions, and decision-making. While we are aware of the methodological problems and confounds posed by studying a """"""""sick, disabled, and old population"""""""", we bring to this project two groups with a history of a successful collaboration in a two-center psychotherapy study, complementary expertise in treatment studies and psychotherapy research, and experience in directing multicenter studies. Moreover, the project will be supported by the structures of the Cornell Advanced Center for Interventions and Services Research (ACISR), whose principal objective is to develop treatment interventions targeting depressed elders with specific clinical and biological characteristics. Accordingly, we are well positioned to meet the challenges inherent in this difficult but important area of research. If CM-PST were found efficacious, it may be offered by trained case-workers of social services to large numbers of depressed, homebound, low-income elders.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH075900-03
Application #
7588732
Study Section
Interventions Committee for Disorders Related to Schizophrenia, Late Life, or Personality (ITSP)
Program Officer
Niederehe, George T
Project Start
2007-04-01
Project End
2012-03-31
Budget Start
2009-04-01
Budget End
2010-03-31
Support Year
3
Fiscal Year
2009
Total Cost
$312,863
Indirect Cost
Name
University of California San Francisco
Department
Psychiatry
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Alexopoulos, George S; O'Neil, Robert; Banerjee, Samprit et al. (2017) ""Engage"" therapy: Prediction of change of late-life major depression. J Affect Disord 221:192-197
Alexopoulos, George S; Raue, Patrick J; Gunning, Faith et al. (2016) ""Engage"" Therapy: Behavioral Activation and Improvement of Late-Life Major Depression. Am J Geriatr Psychiatry 24:320-6
Alexopoulos, George S; Raue, Patrick J; McCulloch, Charles et al. (2016) Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial. Am J Geriatr Psychiatry 24:50-59
Areán, Patricia A; Raue, Patrick J; McCulloch, Charles et al. (2015) Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults. Am J Geriatr Psychiatry 23:1307-1314
Alexopoulos, George S; Raue, Patrick J; Kiosses, Dimitris N et al. (2015) Comparing engage with PST in late-life major depression: a preliminary report. Am J Geriatr Psychiatry 23:506-13
Alexopoulos, G S; Arean, P (2014) A model for streamlining psychotherapy in the RDoC era: the example of 'Engage'. Mol Psychiatry 19:14-9
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
Bistricky, Steven L; Mackin, R Scott; Chu, Joyce P et al. (2010) Recruitment of African Americans and Asian Americans with late-life depression and mild cognitive impairment. Am J Geriatr Psychiatry 18:734-42
Arean, Patricia A; Mackin, Scott; Vargas-Dwyer, Eleanor et al. (2010) Treating depression in disabled, low-income elderly: a conceptual model and recommendations for care. Int J Geriatr Psychiatry 25:765-9
Ayalon, Liat; Fialová, Daniela; Areán, Patricia A et al. (2010) Challenges associated with the recognition and treatment of depression in older recipients of home care services. Int Psychogeriatr 22:514-22

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