A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial

Abstract

Background: Effective care models for treating older African Americans with depressive symptoms are needed.

Objective: To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.

Design: Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680).

Setting: A senior center and participants' homes from 2008 to 2010.

Patients: African Americans aged 55 years or older with depressive symptoms.

Intervention: A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months.

Measurements: Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months.

Results: Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, -2.9 [95% CI, -4.6 to -1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, -3.7 [CI, -5.4 to -2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months.

Limitation: The study had a small sample, short duration, and differential withdrawal rate.

Conclusion: A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans.

Primary funding source: National Institute of Mental Health.

Figures

Figure 1. Study flow diagram

BTB = Beat the Blues; IHSP = In-Home Support Program. * Three participants had 8-mo follow-up but missed 4-mo follow-up. † One participant had 8-mo follow-up but missed 4-mo follow-up.