There is substantial evidence of high rates of depressive symptomatology among individuals hospitalized for medical reasons. While lower rates of recovery are associated with elevated depressive symptomatology, little research has been undertaken to implement and evaluate clinical programs designed to identify and treat the depressive symptoms. A randomized, partially blinded clinical trial to evaluate the feasibility and efficacy of a psychosocial intervention program, delivered by a psychiatric nurse clinical specialist and focused on medically ill, hospitalized older individuals with DSMIIIR dysthymia or adjustment disorder or elevated levels of depressive symptomatology is proposed. Two hundred individuals 65 years and older who are hospitalized on the medicine service of the Medical College of Pennsylvania during the 24 months, May 1991-April 1993, and who have elevated levels of depressive symptoms (Geriatric Depression Scale Scores, GDS, greater than 10) will be recruited into the intervention trial and twelve month follow-up study. One hundred additional patients (Group C), who meet study criteria but who have low levels of depressive symptoms (GDS less than 8) will be recruited into the follow-up component of the study. After recruitment, all cooperative, eligible patients will be evaluated for psychiatric morbidity by the psychiatric clinical nurse specialist. Individuals meeting criteria for DSMIIIR major depression will be referred to the psychiatry consultation-liaison service. Patients meeting study criteria for depressive disorder will be randomly assigned to either the experimental Group A or comparison Group B. A psychosocial intervention based on the Interpersonal Counseling Approach developed by Klenman and Weissman will be introduced to members of the experimental group (Group A) by the psychiatric clinical nurse specialist during the hospital stay. The major components of the treatment program will be conducted in the outpatient setting following hospital discharge. Comparison group members, Group B, will receive """"""""usual care"""""""". Three, six and 12 months following the initial interview, study participants in Groups A, B and C will be interviewed by a trained research interviewer. We hypothesize individuals in experimental Group A will experience short- term (3 month) and long-term (6 and 12 month) benefits including: reduced levels of depressive symptomatology, lower rates of rehospitalization, longer time to re-hospitalization when it does occur, higher levels of good ADL and IADL functioning, fewer ill-bed days, less frequent use of the physician for medical reasons, fewer complications or exacerbations of the presenting medical problems, less use of non-psychotropic medications and lower rates of mortality and/or longer survival time. This study will permit: evaluation of an innovative treatment program for depressive symptomatology and further investigation of the importance of depressive symptoms for course of illness and recovery.
| Mossey, J M; Knott, K A; Higgins, M et al. (1996) Effectiveness of a psychosocial intervention, interpersonal counseling, for subdysthymic depression in medically ill elderly. J Gerontol A Biol Sci Med Sci 51:M172-8 |
