Senior Peer Alliance for Rural Research On Wellness (SPARROW)

Inclusion Criteria:

• Residence in rural Tuolumne, Calaveras, San Joaquin or Stanislaus Counties;
• Diagnosis: Major depression, unipolar (by SCID ascertained DSM-IV criteria);
• Severity of depression: A PHQ-9>10 or a 24-Item HDRS>19;
• Need for social services: CANE score> 2, i.e. at least one unmet need;

Exclusion Criteria:

• Psychotic depression by SCID-IV, i.e., presence of delusions;
• High suicide risk, i.e. intent or plan to attempt suicide in near future;
• Presence of any Axis I psychiatric disorder or substance abuse other than unipolar major depression;
• Axis II diagnosis of antisocial personality (by SCID-P and DSM-IV);
• History of psychiatric disorders other than unipolar major depression or generalized anxiety disorder (including bipolar disorder, hypomania, and dysthymia);
• Dementia: MMSE below 24 or clinical diagnosis of dementia by DSM-IV;
• Acute/severe medical illness (delirium, metastatic cancer, de-compensated cardiac, liver or kidney failure, stroke or myocardial infarction) 3 months prior to entry; or use of drugs causing depression, (steroids, reserpine, alphamethyl-dopa, tamoxiphen, vincristine);
• Inability to perform any of the ADLs (MAI: ADL subscale) even with assistance (walking with a cane is not an exclusion criterion)
• Inability to speak English;
• Aphasia interfering with communication;