Home-based Intervention By Social Workers May Reduce Depressive Symptoms for Older African-Americans

EBM Focus - Volume 8, Issue 36

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Reference: (Ann Intern Med 2013 Aug 6;159(3):243), (level 2 [mid-level] evidence)

The prevalence of clinically relevant depressive symptoms in older African-Americans is higher than in the general public, with estimates of 21% or more (J Am Geriatr Soc. 2004 May;52(5):741), but these individuals may be reluctant to seek treatment due to lack of awareness of symptoms, a perceived stigma associated with seeking care, or limitations in accessing care. A recent randomized trial evaluated the efficacy of the “Beat the Blues” program, a multicomponent, social worker-led intervention bringing depression care management into the home.

A total of 208 African-American patients ≥ 55 years old (mean age 70 years) with depressive symptoms were randomized to the “Beat the Blues” intervention vs. wait-list control for 4 months and followed for 8 months. The intervention consisted of 1-hour at-home sessions with a social worker covering depression education and instruction in symptom identification, stress reduction techniques, and behavioral activation for identifying and achieving goals. The social worker also provided care management with assessment of unmet care needs, referrals, and linking to social and medical services. The sessions were held weekly for up to10 weeks, and biweekly thereafter until 4 months. Patients in the wait list group received no intervention for the first 4 months, and then started the “Beat the Blues” program at 4 months.

Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9, range 0-27 points). Remission was defined as a total score < 5 points, and any reduction in score of at least 5 points was considered clinically meaningful. In an analysis of 87% of the randomized patients at 4 months, the remission rates were 43.8% in the “Beat the Blues” group and 26.9% in the control group (p = 0.02, NNT 6). Clinically-meaningful reductions in symptom severity occurred in 64% with the intervention vs. 41% with control (p value not reported). “Beat the Blues” was associated with significant improvements from baseline in anxiety, quality of life, behavioral activation, and functional difficulty. These improvements in depressive symptoms and other outcomes were maintained at 8 months, with no significant changes from their 4-month results. Patients from the control group who participated in the intervention during the second 4 month period showed similar improvements from baseline in depressive symptoms and other measures at the end of treatment.

For more information, see the Depression topic in DynaMed.