BRIGHTEN Heart intervention for depression in minority older adults: Randomized controlled trial

Abstract

Objective: Assess the effectiveness of an interdisciplinary geriatric team intervention in decreasing symptoms of depression among urban minority older adults in primary care. Secondary outcomes included cardiometabolic syndrome and trauma.

Method: 250 African American and Hispanic older adults with PHQ-9 scores ≥ 8 and BMI ≥ 25 were recruited from 6 underserved urban primary care clinics. Intervention arm participants received the BRIGHTEN Heart team intervention plus membership in Generations, an older adult educational activity program; comparison participants received only Generations.

Results: Both arms demonstrated clinically significant improvements in PHQ-9 scores at 6 months (-5 points, intervention and comparison) and 12 months (-7 points intervention, -6.5 points comparison); there was no significant difference in change scores between groups on depression or cardiometabolic syndrome at 6 months; there was a small difference in depression trajectory at 12 months (p < .001). More participants in the treatment group (70.7%) had greater than 50% reduction in PHQ-9 scores than the comparison group (56.3%; p = .036). For those with higher PTSD symptoms (PCL-C6), improvement in depression was significantly better in the intervention arm than the comparison arm, regardless of baseline PHQ-9 (p = .001). In mixed models, those with higher PTSD symptoms (β = -0.012, p = < 0.001) in the intervention arm showed greater depression improvement than those with lower PTSD symptoms (β = -0.004, p = .001).

Conclusions: The BRIGHTEN Heart intervention may be effective in reducing depression for urban minority older adults. Further research on team care interventions and screening for PTSD symptoms in primary care is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT01428791.

Figures

Figure 1:

Study Consort Diagram a. Patients who refused intervention were continued in follow-up until they completed, died, fully withdrew, or were lost to follow-up. b. Follow-up at 12 months c. Primary analysis at 6 months

Figure 2.. Predicted PHQ-9 Values

a Based on a GLMM model with a Poisson distribution, unstructured covariance matrix and random intercept predicting PHQ-9 over 12 months. β coefficients on a linear-predictor scale (ie log of outcome). Similar results were found after adjusting for Age, gender and ethnicity. Beta coefficients are on a linear-predictor scale (i.e. log of outcome) and should be interpreted as the percent difference.