This application is in response to the NIH-NIMH program announcement (PAR-05-026) """"""""Community Participation in Research."""""""" Based on a strong collaborative partnership between an academic research center at Thomas Jefferson University, and a senior center, Center in the Park (CIP), we plan to test the effectiveness of an in-home intervention to treat depression in 192 urban African American elders. Using a two group randomized trial, we will test a brief intervention that combines evidentiary components (depression education, stress reduction, referral, care management and behavioral activation) and mode of delivery (in-home) that resonate with the socio-cultural attributes of the target community. Participants will be enrolled from over 6,000 CIP members who screen positive for depressive symptoms. Study participants will be interviewed at baseline at home and then randomized to treatment or a wait-list control group. Participants in treatment will receive up to 10 in-home sessions from a CIP social worker while wait-list controls will receive usual care. All participants will be reassessed at 4 months by telephone (main trial endpoint) at which point wait-list controls will be offered the intervention and then all study participants will be reassessed at 8 months by telephone. Specific study aims are to: 1 )Test the immediate effect of the intervention at 4-months on depression (between group comparison);2) Test the maintenance effect of the intervention at 8-months on depression (within group comparison);3) Evaluate acceptability (social validity) of the intervention and engagement in targeted activities (experimental and wait-list control participants). A secondary aim will assess the feasibility of conducting a clinical trial embedded in a community setting and its dissemination using a community-academic partnership. Three exploratory aims will evaluate the mediational role of behavioral activation, differential treatment effects based on participant characteristics, and the effect of the intervention on quality of life domains. Health disparities coupled with unequal access to culturally relevant mental health treatments are consistently documented for older African Americans. Depression is a debilitating but treatable condition contributing to poor life quality. Our research will identify culturally-relevant depression treatment for African American elders, enhance service capacity of senior centers to treat depression in the community, and disseminate a replicable partnership model.
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