Effectiveness of Case Management with Problem-Solving Therapy for Rural Older Adults with Depression.

Autor:	Hollister B; University of California, San Francisco (BH, RC, SK, MB); Center for Caring Research, University of Agder, Norway (BH). Electronic address: brooke.hollister@ucsf.edu., Crabb R; University of California, San Francisco (BH, RC, SK, MB)., Kaplan S; University of California, San Francisco (BH, RC, SK, MB)., Brandner M; University of California, San Francisco (BH, RC, SK, MB)., Areán P; University of Washington.
Jazyk:	angličtina
Zdroj:	The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry [Am J Geriatr Psychiatry] 2022 Oct; Vol. 30 (10), pp. 1083-1092. Date of Electronic Publication: 2022 Mar 09.
DOI:	10.1016/j.jagp.2022.03.001
Abstrakt:	Objective: To evaluate the effect of case management with problem solving therapy (CM-PST) on depression and disability among rural older adults and compare its effect with outcomes derived from a previous, but similar study among 84 urban older adults. Methods: This study examined the comparative effectiveness of a CM-PST intervention for older adults with depression and unmet needs across rural and urban settings. Participants received 12 one-hour sessions of CM-PST with a master's-level clinician. A total of 56 rural and 84 urban adults aged 60 and older experiencing mild to moderate depression received services in their homes. Results: The rural CM-PST intervention resulted in significantly reduced depression (reduction of 13.9 points, 95% CI 12.2 to 15.7, t(422)= 15.35, p<0.0001) and disability by week 12 (reduction of 6.7 points, 95% CI 4.8 to 8.5, t(425)= 7.01, p<0.0001). Reductions in depression and disability were sustained through week 24. The reductions in depression (F=3.98 df=4,388. p=0.0035) and disability (F=2.71, df=4,381, p=0.03) found in the rural sample were comparable to, or better than, those found in the urban sample. Improvements in unmet need and resilience predicted lower depression scores at 12 weeks, while improvements in unmet need and hopelessness predicted improvements in disability. No moderators of depression were identified, but baseline values of self-efficacy, resilience, and hopelessness moderated disability. Conclusions: CM-PST was as effective at reducing depression and disability among rural older adults as it was for urban older adults. Home-delivered CM-PST can be successfully adapted to meet the specific needs of rural seniors using resources often available in rural communities. Competing Interests: DISCLOSURES The authors have no disclosures to report. (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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