Calmer Life: Treating Worry Among Older Adults In Underserved, Low-income, Minority Communities

The purpose of this research study is to see how helpful two different interventions offered through the Calmer Life program are in reducing worry and improving mood. The investigators also want to understand how a program like Calmer Life can be offered in underserved communities.

Study Overview

• Status: Completed
• Conditions: Anxiety
• Intervention / Treatment: Behavioral: Cognitive behavior treatment; Behavioral: Information and referral

Detailed Description

Background: Recurrent, excessive, uncontrollable worry about multiple topics is common in older adults, but it is not well studied. This significant worry can negatively affect thinking, and it is associated with poorer sleep, more depression, and worse general health. Despite its prevalence, researchers have not studied significant worry enough, particularly in low-income racial and ethnic minority populations. We know these groups are unlikely to have adequate mental health care. We also know that older adults and minorities prefer treatments for worry that do not require medication, and that these kinds of treatments can be effective. Additional tests of treatments that do not involve drugs are needed in low-income racial and ethnic minority populations. Such person-centered research could expand access to appropriate care.

Objectives: The study team plans to compare two approaches, one called Calmer Life (CL) and another called Enhanced Community Care (ECC). CL helps individuals by providing worry-reduction skills and resource counseling for basic needs in a flexible, culturally supportive manner. ECC relies on standard information and resource counseling. The study will answer three questions. First, compared to ECC, is CL more effective at relieving significant worry? Second, which one is more effective at reducing anxiety and depression and improving sleep, ability to do daily activities, and use of medical services? Third, are improvements still present three months after treatment concludes?

Methods: In agreement with our community partners and governed by a council of community leaders, consumers, and providers from low-income minority communities, we will conduct the study. This community-academic partnership, created four years ago, introduced CL to the community. Case managers and community health workers from partner organizations were trained to implement CL. They taught worry-reduction skills and helped participants increase their use of community resources. Content was flexible so that participants could choose which skills to learn and whether or not to include religion or spirituality. They also could learn skills at home, by telephone, or in the community. In a new, larger comparison study, we will enroll 120 women and 30 men who are 50 years of age or older with significant worry. Most (80 percent) will be African American, and 70 percent will have income below poverty. Participants will be assigned by chance to CL or ECC and treated for six months. Brief assessments at enrollment and at six and nine months will rely on participants' reports. Differences will be measured statistically.

• Study Type: Interventional
• Enrollment (Actual): 247
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • VA HSR&D Center for Innovations in Quality, Effectiveness & Safety (IQuESt)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• PSWQ greater than 22

Exclusion Criteria:

• PHQ score less than 20
• Active suicidal intent
• Active psychosis or bipolar disorder
• Substance abuse
• Cognitive impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Calmer Life; Cognitive behavior treatment for anxiety	Behavioral: Cognitive behavior treatment; Anxiety management skills with the option to included religious/spiritual beliefs and practices
Active Comparator: Enhanced Community Care; Enhanced information and referral services for mental health and basic needs	Behavioral: Information and referral; Resource counseling and follow-up for mental health and basic needs

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Penn State Worry Questionnaire - A (PSWQ-A) at 6 Months	Brief measure of worry with 8 items measured on a 1-5 scale (1 = not at all typical, 3 = somewhat typical, 5 = very typical). Scores range from 8 to 40. Higher scores indicate greater anxiety.	Baseline, 6 months
Penn State Worry Questionnaire - A (PSWQ-A) at 9 Months	Brief measure of worry with 8 items measured on a 1-5 scale (1 = not at all typical, 3 = somewhat typical, 5 = very typical). Scores range from 8 to 40. Higher scores indicate greater anxiety.	Baseline, 9 months
Generalized Anxiety Disorder-7 (GAD-7) at 6 Months	Measure of Generalized Anxiety Disorder symptoms. 7 items rated from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 21. Higher scores indicate greater GAD symptoms.	Baseline, 6 months
Generalized Anxiety Disorder-7 (GAD-7) at 9 Months	Measure of Generalized Anxiety Disorder symptoms. 7 items rated from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 21. Higher scores indicate greater GAD symptoms.	Baseline, 9 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Geriatric Anxiety Inventory - SF (GAI-SF) at 6 Months	Five item scale with response options of yes = 1 and no = 0 to each item. Scores range from 0 to 5. Greater scores indicate greater anxiety.	Baseline, 6 months
Geriatric Anxiety Inventory - SF (GAI-SF) at 9 Months	Five item scale with response options of yes = 1 and no = 0 to each item. Scores range from 0 to 5. Greater scores indicate greater anxiety.	Baseline, 9 months
Patient Health Questionnaire Depression Scale (PHQ 8) at 6 Months	Brief measure of depression symptoms consisting of 8 items rated from 0-3 (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day). Scores range from 0 to 24. Higher scores indicate greater depression severity.	Baseline, 6 months
Patient Health Questionnaire Depression Scale (PHQ 8) at 9 Months	Brief measure of depression symptoms consisting of 8 items rated from 0-3 (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day). Scores range from 0 to 24. Higher scores indicate greater depression severity.	Baseline, 9 months
Geriatric Depression Scale Short Form (GDS) at 6 Months	Brief measure of depression designed for use with older adults consisting of 15 items rated yes (1) or no (0). Scores range from 0 to 15. Higher scores indicate greater depression.	Baseline, 6 months
Geriatric Depression Scale Short Form (GDS) at 9 Months	Brief measure of depression designed for use with older adults consisting of 15 items rated yes (1) or no (0). Scores range from 0 to 15. Higher scores indicate greater depression.	Baseline, 9 months
Insomnia Severity Index (ISI) at 6 Months	Measure of sleep difficulties consisting of 7 items rated on a 0-4 scale. Scores range from 0 to 28. Higher scores indicate greater sleep difficulties.	Baseline, 6 months
Insomnia Severity Index (ISI) at 9 Months	Measure of sleep difficulties consisting of 7 items rated on a 0-4 scale. Scores range from 0 to 28. Higher scores indicate greater sleep difficulties.	Baseline, 9 months
Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Frequency at 6 Months	Measure that assesses disability frequency across 16 life tasks and social roles. Frequencies for the 16 items are rated on a scale from 1 (never) to 5 (very often). Summary scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher participation in tasks/higher functioning.	Baseline, 6 months
Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Frequency at 9 Months	Measure that assesses disability frequency across 16 life tasks and social roles. Frequencies for the 16 items are rated on a scale from 1 (never) to 5 (very often). Summary scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher participation in tasks/higher functioning.	Baseline, 9 months
Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Limitation at 6 Months	Measure that assesses disability limitations across 16 life tasks and social roles. Limitations for the 16 items are rated on a scale from 1 (completely limited) to 5 (not at all limited). Raw scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher levels of capability of participating in tasks/higher functioning.	Baseline, 6 months
Late-Life Function and Disability Instrument (LL-FDI) Disability Subscale - Limitation	Measure that assesses disability limitations across 16 life tasks and social roles. Limitations for the 16 items are rated on a scale from 1 (completely limited) to 5 (not at all limited). Raw scores are transformed to scaled summary scores ranging from 0 to 100. Higher scores represent higher levels of capability of participating in tasks/higher functioning.	Baseline, 9 months
Medical Outcomes Study 12-Item Short-Form Health Survey Physical Component Summary (SF-12 PCS) at 6 Months	Physical component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100. Higher scores indicate higher levels of physical functioning.	Baseline, 6 months
Medical Outcomes Study 12-Item Short-Form Health Survey Physical Component Summary (SF-12 PCS)	Physical component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100. Higher scores indicate higher levels of physical functioning.	Baseline, 9 months
Medical Outcomes Study 12-Item Short-Form Survey Mental Component Summary (SF-12 MCS) at 6 Months	Mental component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100.Higher scores indicate higher levels of mental health functioning.	Baseline, 6 months
Medical Outcomes Study 12-Item Short-Form Survey Mental Component Summary (SF-12 MCS) at 9 Months	Mental component summary score of the 12-item Medical Outcomes Study Short Form (SF-12), a measure of health-related quality of life. Summary raw scores are transformed to scale scores ranging from 0 to 100.Higher scores indicate higher levels of mental health functioning.	Baseline, 9 months
PTSD Checklist-5 (PCL-5) Total at 6 Months	Measure of PTSD symptoms. 20 items rated from 0 (not at all) to 4 (extremely). Scores range from 0 to 80. Higher scores = higher symptom severity.	Baseline, 6 months
PTSD Checklist-5 (PCL-5) Total at 9 Months	Measure of PTSD symptoms. 20 items rated from 0 (not at all) to 4 (extremely). Scores range from 0 to 80. Higher scores = higher symptom severity.	Baseline, 9 months
Health Service Use at 6 Months	Number of participants who had visited a health care provider (e.g., physician, nurse, physician's assistant) over the past 3 months.	Baseline, 6 months
Health Service Use at 9 Months	Number of participants who had visited a health care provider (e.g., physician, nurse, physician's assistant) over the past 3 months.	Baseline, 9 months
Hospital Admissions at 6 Months	Number of participants who were admitted to a hospital in the past 3 months.	Baseline, 6 months
Hospital Admissions at 9 Months	Number of participants who were admitted to a hospital in the past 3 months.	Baseline, 9 months
Social Service or Resource Use at 6 Months	Number of participants who received social services or resources over the past 3 months	Baseline, 6 months
Social Service or Resource Use at 9 Months	Number of participants who received social services or resources over the past 3 months	Baseline, 9 months
Psychological Service Use at 6 Months	Number of participants who discussed personal or emotional problems with a medical provider, clergy, mental health provider, or support group over the past 3 months	Baseline, 6 months
Psychological Service Use at 9 Months	Number of participants who discussed personal or emotional problems with a medical provider, clergy, mental health provider, or support group over the past 3 months	Baseline, 9 months

Collaborators and Investigators

• Sponsor: Baylor College of Medicine
• Collaborators: Patient-Centered Outcomes Research Institute
• Investigators: Principal Investigator: Melinda A Stanley, PhD, Baylor College of Medicine

Publications and helpful links

General Publications

• Stanley MA, Wilson NL, Shrestha S, Amspoker AB, Wagener P, Bavineau J, Turner M, Fletcher TL, Freshour J, Kraus-Schuman C, Kunik ME. Community-Based Outreach and Treatment for Underserved Older Adults With Clinically Significant Worry: A Randomized Controlled Trial. Am J Geriatr Psychiatry. 2018 Nov;26(11):1147-1162. doi: 10.1016/j.jagp.2018.07.011. Epub 2018 Aug 7.
• Steiner AJ, Boulos N, Wright SM, Mirocha J, Smith K, Lopez E, Gohar SH, Ishak WW. Major Depressive Disorder in Patients With Doctoral Degrees: Patient-reported Depressive Symptom Severity, Functioning, and Quality of Life Before and After Initial Treatment in the STAR*D Study. J Psychiatr Pract. 2017 Sep;23(5):328-341. doi: 10.1097/PRA.0000000000000251.
• Shrestha S, Wilson N, Kunik ME, Wagener P, Amspoker AB, Barrera T, Freshour J, Kraus-Schuman C, Bavineau J, Turner M, Stanley MA. Calmer Life: A Hybrid Effectiveness-implementation Trial for Late-life Anxiety Conducted in Low-income, Mental Health-Underserved Communities. J Psychiatr Pract. 2017 May;23(3):180-190. doi: 10.1097/PRA.0000000000000234.

Study record dates

Study Major Dates

• Study Start: November 1, 2014
• Primary Completion (Actual): September 1, 2017
• Study Completion (Actual): February 1, 2018

Study Registration Dates

• First Submitted: February 26, 2015
• First Submitted That Met QC Criteria: March 12, 2015
• First Posted (Estimate): March 18, 2015

Study Record Updates

• Last Update Posted (Actual): May 31, 2019
• Last Update Submitted That Met QC Criteria: February 14, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Keywords: anxiety; worry
• Other Study ID Numbers: AD-1310-06824