Mediators of the impact of a home-based intervention (beat the blues) on depressive symptoms among older African Americans.

Abstract

Older African Americans (N=208) with depressive symptoms were randomly assigned to a home-based nonpharmacologic intervention (Beat the Blues, BTB) or wait-list control group. BTB was delivered by licensed social workers and involved up to 10 home visits focused on care management, referral and linkage, depression knowledge and efficacy in symptom recognition, instruction in stress reduction techniques, and behavioral activation through identification of personal goals and action plans for achieving them. Structured interviews by assessors masked to study assignment were used to assess changes in depressive symptoms (main trial endpoint), behavioral activation, depression knowledge, formal care service utilization and anxiety (mediators) at baseline and 4-months. At 4-months, the intervention had a positive effect on depressive symptoms and all mediators except formal care service utilization. Structural equation models indicated that increased activation, enhanced depression knowledge, and decreased anxiety each independently mediated a significant proportion of the intervention’s impact on depressive symptoms as assessed with two different measures (PHQ-9 and CES-D). These three factors also jointly explained over 60% of the intervention’s total effect on both indicators of depressive symptoms. Our findings suggest that most of the impact of BTB on depressive symptoms is driven by enhancing activation or becoming active, reducing anxiety, and improving depression knowledge/efficacy. The intervention components appear to work in concert and may be mutually necessary for maximal benefits from treatment to occur. Implications for designing tailored interventions to address depressive symptoms among older African Americans are discussed.

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

“…The intervention has been described elsewhere . It involved up to 10 one‐hour sessions at home conducted over 4 months by licensed social workers trained in the protocol.…”

“…Increasing behavioral activation, enhancing depression knowledge and symptom recognition, and decreasing anxiety each independently mediated a significant proportion of the intervention's effect on depressive symptoms and jointly explained more than 60% of the intervention's total effect on depressive symptoms. That these measures reflect the intervention's treatment components suggests that they work in concert and are mutually necessary for maximal benefits on depressive symptoms to occur . It was also previously reported that the intervention not only reduced depressive symptoms, but also afforded important benefits in other outcomes, including functional disability, anxiety, depression knowledge and symptom recognition, and behavioral activation …”

“…Behavioral activation, depression knowledge and symptom recognition, and anxiety were considered as mediators of functional disability given their role in mediating treatment effect on depressive symptoms . If each measure or a combination thereof explained treatment effects on functional disability, then it could be concluded that similar mechanisms account for disparate treatment outcomes in depression trials.…”

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

“…Fuente: propia del autor. depresivos 51 . Esto evidencia la necesidad de trabajar sobre la reducción de síntomas depresivos y la mejoría de la funcionalidad como determinantes complementarios, comprendiendo cómo la persona mayor experimenta la sintomatología depresiva y ansiosa en la ejecución de actividades habituales y roles de interés.…”

Valuation of Life as outcome and mediator of a depression intervention for older African Americans: the Get Busy Get Better Trial

“…If that is the case, it would be important to identify all possible conduits by which a behaviorally oriented intervention might have a positive effect in order to optimize efficiency in its delivery and strengthen derived benefits. We previously showed that positive changes in levels of activation, depression knowledge and symptom detection, and anxiety each mediated the relationship between GBGB and depressive symptoms, whereas other changes such as in physical function or utilization of formal care and services did not (Gitlin et al ., ).…”