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.
