A Family-based Primary Care Intervention to Enhance Older Men’s Depression Care

Overview

Despite the public health importance of clinical depression, more than 50% of depressed adults receive inadequate or no treatment, with even higher rates of under-treatment in men and minorities. Family members and/or friends often assist older adults in their health care and may help overcome barriers to formal care, yet there is a lack of primary care-based interventions that mobilize family members and friends to improve depression treatment. In partnership with a community-based clinic, this research will address this scientific gap by developing and then testing the feasibility and acceptability of a family-based intervention that can be delivered pragmatically in a primary care setting serving large numbers of older minorities.

Full Title of Study: “A Family-based Primary Care Intervention to Enhance Older Men’s Depression Care”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: December 31, 2016

Detailed Description

The family-based intervention will be tested in a 6 month randomized controlled trial of 24 depressed older men-family member dyads (18 intervention and 6 controls). The purpose of the RCT is to test the acceptability of the intervention, as well as the feasibility of the study methods. Patients from the RCT will be identified from a family practice clinic based on their scores on the PHQ-9 as well as additional inclusion and exclusion criteria. Once they and their family member have agreed to participate, patients will be randomized either to the family based intervention or a usual care control condition augmented by family psychoeducation. The investigators will recruit English and Spanish speaking age 60 and above older men from SJGH who have 1) significant depressive symptoms (i.e. PHQ > 15, 2) have at least one criteria A symptom (depressed mood or anhedonia), 3) depression-related functional impairment) and 4) an adult family member willing to participate in the study. We have chosen a higher cut-off to minimize false positives. We will exclude psychotic, demented or institutionalized men. After enrollment, 24 dyads (i.e. older man and family member) will be randomized one of two groups: intervention or usual care augmented by written psychoeducational materials on depression. Dyads will be randomized to achieve a 2:1 ratio of intervention versus usual care dyads (i.e. 18 intervention and 6 control dyads). To ensure adequate numbers of ethnic minority patients in each arm of the trial, we will conduct a stratified randomization such that each arm of the RCT is 50% English language preferring and 50% Spanish language preferring (i.e. 3 in control and 9 in intervention arm). The research assistant will conduct subject assessment at baseline, 1-month, 3-months and 6 months.

Interventions

  • Behavioral: Family-based depression intervention
    • The primary focus of our approach is on effectively engaging family members of depressed older men in the care of the patient. The interventionist (social worker) will 1) work jointly with a family member and older men to strengthen depression self-management and participation during primary care visits and 2) conduct a brief training module for primary care provider skills to strengthen their skills in working with family members.
  • Behavioral: Usual care plus educational materials
    • Control subjects will receive usual care in the clinic augmented by psychoeducation. Family members will be given standard psychoeducational materials on depression.

Arms, Groups and Cohorts

  • Experimental: Family-based depression intervention
    • The family-focused component will consist of up to up to 10 joint (i.e. older man alone and/or with family members) sessions that will cover specific topics related to family support of men’s depression care provided by a clinic-based social worker
  • Active Comparator: Usual care plus educational materials
    • Control subjects will receive usual care in the clinic enhanced by a single depression psychoeducation session.

Clinical Trial Outcome Measures

Primary Measures

  • Depressive symptoms
    • Time Frame: up to 6 months

Participating in This Clinical Trial

Inclusion Criteria

  • men, age 60 and above, English or Spanish speaking, significant depressive symptoms (i.e. PHQ > 15, have at least one criteria A symptom (depressed mood or anhedonia), depression-related functional impairment, have an adult family member willing to participate in the study

Exclusion Criteria

  • psychotic, demented, institutionalized

Gender Eligibility: Male

Minimum Age: 60 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of California, Davis
  • Collaborator
    • University of Washington
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Ladson Hinton, MD, Principal Investigator, University of California, Davis

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