Depression is a major burden for minority and low-income older adults who are less likely to use mental health services, and development of new service delivery models is needed to improve the quality of life and address disparities to access for this group. We propose to test the effectiveness of a peer- delivered depression care program that is embedded in the community and linked to the patient's primary care clinic.
Our first aim will be to carry out a randomized controlled trial of the Peer Enhanced Depression Care program in which peer mentors who have personal experience of depression meet individually with older adults recruited in the community for 8 weekly meetings focused on relief of depressive symptoms through self-care support and linkages to community resources. This group of low-income and minority older adults in the intervention will be compared to a group that receives non- peer visits that provide social interaction. The Peer Enhanced Depression Care program takes a chronic disease self-management approach and is guided by the conceptual frameworks of social support, peer support, and social learning.
Our second aim i s to understand mediators such as self-efficacy and loneliness that may be responsible for the intervention effect.
Our third aim i s to evaluate the implementation of the intervention by conducting interviews with stakeholders, including older adults who received the intervention, peer mentors, social workers, the older adult's primary care physicians and health system administrators to obtain their perspectives on barriers and facilitators to implementation as well as the impact of the Peer Program. Our goal is to use peer-delivered depression care to decrease the mental health morbidity of at-risk low-income and minority adults. The potential public health impact is high because our project seeks to increase access to depression for a vulnerable group of older adults who often do not get care and leverages an existing workforce of peer workers whose services are reimbursed in many states.
Fifteen to twenty percent of older Americans (6 to 8 million people) suffer from depression but more than one- half do not receive any services, a burden disproportionately shared by low-income and minority older adults who receive few or no services. We propose to test a community-based peer model of depression care that provides self-care support for minority and low-income older adults recruited from primary care settings. Our project has potential for high public health impact, specifically, to increase access to depression care for vulnerable and underserved older adults and meet the needs of health systems that are extending beyond medical models of care to include lay worker and community-based resources.
