Factors Mediating the Effects of a Depression Intervention on Functional Disability in Older African Americans

Abstract

Background/Objectives Determine factors mediating the effects of a depression intervention for older African Americans on functional disability; and secondarily, if functional improvements mediated intervention effects on depressive symptoms. Design Structural equation modeling to examine mediators in a secondary analysis of a randomized trial with 4-month follow-up Setting Community-dwelling population in Philadelphia region Participants 208 African Americans (≥55) with depressive symptoms living in an urban area Intervention Up to 10, one-hour sessions over 4 months conducted by licensed social workers who provided care management, referral/linkages, stress reduction techniques, depression knowledge and symptom recognition and behavioral activation techniques. Measurements Main outcome was self-reported functional difficulty level for 18 basic activities. Mediators included depression severity (PHQ-9), depression knowledge/symptom recognition, behavioral activation and state anxiety. Results At 4-months, compared to controls, the intervention had positive effects on functional difficulty and all mediators (ps< .0001). Separate structural equation models indicated the intervention’s impact on functional disability was significantly mediated by two factors, reduced depressive symptoms (23.5% mediated) and improved depression knowledge/symptom recognition (52.9% mediated). Enhancing behavioral activation and decreasing anxiety were not found to mediate improvements in functional disability. The two significant mediators jointly explained 62.5% of the intervention’s total effect on functional disability. Functional improvement was not found to mediate the intervention’s impact on depressive symptoms. Conclusion This multi-component depression intervention for African Americans has an impact on functional disability that is driven primarily by enhancing symptom recognition and decreasing depressive symptoms. Reduction of functional difficulties however did not account for improvements in depressive symptoms. Nonpharmacologic treatments for depressive symptoms that enhance symptom recognition in older African Americans can also reduce their functional difficulties with daily living activities.

A Cross-Disciplinary Successful Aging Intervention and Evaluation: Comparison of Person-to-Person and Digital-Assisted Approaches

“…Depressive symptoms were not significantly altered by the intervention on coping skills, as shown in other research [ 37 ]. However, mental well-being and positive emotions significantly increased for the P&D group.…”

“…Regarding emotional health, using cognitive psychological therapy (such as acceptance and commitment therapy and mindfulness-based cognitive therapy) may strengthen mental resilience [ 35 ]. Life review [ 36 ], stress coping skills, and case management [ 37 ] may reduce depressive symptoms. Participation in an online support group may reduce depressive symptoms and increase dignity and quality of life [ 38 ].…”

Symptomatic and Functional Recovery From Major Depressive Disorder in the Ibadan Study of Ageing

“…Evidence from clinical trials suggests that, following treatment for late-life depression, functional disability may subsist even after symptomatic recovery. 1 , 2 Nevertheless, few prospective studies of large community samples 3 , 4 have examined whether, as it is in experimental conditions, recovery of physical functioning in the context of late-life depression follows a different course to symptomatic recovery. Better understanding in this area may be important for the development of interventions that target not only symptoms of late-life depression, but also the associated functional disability.…”

Comprendiendo el impacto de los síntomas depresivos en la funcionalidad de las personas mayores

“…Gitlin, et al, observó que el conocimiento que tienen los sujetos de la enfermedad y el reconocimiento de síntomas depresivos pueden ser factores determinantes en la reducción del deterioro funcional en adultos mayores con depresión 12 . La mayor parte del impacto en los síntomas depresivos se desencadena mediante el aumento de la activación o ponerse activo (realizar actividades), la reducción de la ansiedad, y mejorar los conocimientos y sensación de eficacia en relación a los síntomas Figura 3.…”

“…En este contexto, conocer la relación entre los sínto-mas depresivos y la funcionalidad de los adultos mayores, podría tener una importancia como valor predictivo de la evolución de esta condición, e indicador de eficacia de tratamientos dirigidos a reducir los síntomas depresivos en estos sujetos 12,13 . Sin embargo, aún no existe acabada comprensión de los mecanismos por los cuales se genera y se mantiene esta relación, lo que podría ser un aporte para el diseño de intervenciones que tengan como base la mejoría de la funcionalidad y bienestar de la persona mayor.…”