- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02505178
Examining the Feasibility and Effectiveness of Case Manager Delivered Problem Solving Therapy on Late Life Depression
Examining the Feasibility and Effectiveness of Case Manager Delivered Problem Solving Therapy on Late Life Depression; an Open-label Prospective Pilot Study.
Study Overview
Detailed Description
In the elderly (i.e. individuals 60 years of age or older) major depressive disorder (MDD) is common occurring in 2-3% of the population and known as late life depression (LLD). LLD is both disabling and associated with a high mortality rate. Response to treatment of LLD using at least one antidepressant trial of adequate dose and duration is around 30-40%. Due to these suboptimal response rates, additional interventions should be tested and implemented to further alleviate the symptoms and severity of LLD.
It is common for individuals referred to geriatric psychiatry programs to live alone and have impaired independent mobility, which makes them more susceptible to depression as they are at a higher risk for social isolation. Best practice guidelines recommend using psychosocial therapies, which are effective in reducing symptoms of LLD, as the standard treatment for mild to moderate depression, either alone or in combination with medications. PST can be delivered to patients close to their homes making it ideal for treating seniors with limited mobility. The elderly are more likely to suffer from co-morbid conditions and be treated with multiple medications. Antidepressants are associated with serious adverse events, making psychosocial treatments especially important to the elderly who take more medications and are more likely to suffer comorbid conditions.
Problem-solving therapy (PST) is an established psychosocial therapy shown to be effective in treating depression and other mental disorders in adults of all ages. PST involves seven stages of problem resolution including a)identifying and clarifying the problem b)setting clear achievable goals c) brain-storming to generate solutions d) selecting a preferred solution and f) evaluation. Studies of PST in older adults have shown the treatment to be effective in reducing depression. PST has been successfully adapted to meet the needs of seniors with comorbid conditions and those with early dementia or cognitive impairment.
Despite the importance of psychotherapy interventions for older adults with MDD there is limited access to these treatments for seniors. At present, nurse case managers and social work case managers (CM) do not receive formal training in problem solving therapy. Since they often provide treatment for geriatric mental health outpatients, this limits access to treatments like PST. However, if CM's have formal training in PST, this treatment option can be made available to seniors that could benefit from such programs. To the best of the investigators' knowledge no study has evaluated the effects of CM trained to deliver PST for individuals with LLD in Canada, as such, this is the aim of the current investigation.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Ontario
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London, Ontario, Canada, N6A 5W9
- London Health Sciences Centre
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Are of either gender and greater than 60 years of age.
- Reside in a community setting (either independent living environment or retirement home).
- Meet diagnostic criteria for major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) criteria.
- Have a Hamilton Depression Rating Scale (HAMD) 17-item total score of >= 8 and < 24 at baseline.
- Have a Mini Mental Status Exam score of >= 20.
- Have adequate hearing and vision to be able to participate in Problem Solving Therapy.
Exclusion Criteria:
- Have suicidal ideation requiring inpatient admission to hospital for stabilization.
- Have an unstable medical condition requiring hospital admission.
- Have a life expectancy of less than 6 months or are currently receiving palliative care.
- Have psychotic symptoms.
- Have a lifetime history of bipolar disorder or schizophrenia.
- Are currently alcohol dependent or have another substance dependence.
- Are diagnosed with moderate to severe dementia.
- Are planning admission to a long-term care facility within next 6 months.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Problem Solving Therapy
Study participation will involve 9 study visits over a total of 12 weeks.
This includes 5 sessions of Case Manager implemented PST over a period of 8 weeks (week 1, 3, 5, 7, and 9) and 4 assessment visits (baseline, week 4, week 8, and week 12).
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PST is a minimally invasive treatment.
The five sessions of CM implemented PST will involve psychotherapy also known as talk therapy between the CM's and study participants in a group setting.
Psychogeriatric interdisciplinary staff (CM's) i.e. psychiatric nurses, social workers who have been previously trained in PST will function in the roles of facilitator, cofacilitator and scribe.
The roles can be shared amongst the professionals to build capacity in each role or maintained over time if so desired.
Sessions will be approximately one-and-a-half to two hours in length and conducted at the Cherry Hill Mall library in London.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in depression symptoms
Time Frame: Baseline, week 4, and week 8
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Depression in study participants will be self rated on the Patient Health Questionnaire (PHQ-9)
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Baseline, week 4, and week 8
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Quality of Life
Time Frame: Baseline and week 12
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Participants will complete a Short Form-12 to assess the change in their quality of life.
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Baseline and week 12
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Change in Depression Symptoms- Clinician Rated
Time Frame: Baseline, Week 4 and Week 8
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Hamilton scale for Depression-17 item (HAM-D 17), as rated by a clinician trained to complete this scale
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Baseline, Week 4 and Week 8
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Change in Depression Symptoms- Overall improvement
Time Frame: Baseline, Week 4 and Week 8
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Clinical Global Impression- CGI, as rated by a clinician trained to complete this scale
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Baseline, Week 4 and Week 8
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Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 106856
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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