Results Summary
What was the research about?
Depression is a common health problem among older adults. People who are depressed feel sad, hopeless, or empty on most days for more than two weeks. Compared with other adults, Latinxs over age 50 are often depressed for longer and are less likely to get high-quality care for their depression.
This study compared two ways to help Latinx patients age 50 or older with depression. In both groups, patients met with trained staff who spoke English and Spanish but didn’t have training in counseling.
- Programa Esperanza. Patients learned about their mental health and learned skills to help solve their problems. They met one-on-one with staff for about an hour for eight weeks and then for 15 minutes once a month for three months. Patients also received handouts and homework.
- Depression education. Patients had a single one-on-one meeting with staff for one hour. They received handouts and learned about depression, treatment options, and where to find help for depression.
All patients in the study received regular primary care and referrals to mental health services when needed.
What were the results?
After one year, patients in the two groups reported similar levels of depression, anxiety, problem-solving skills, physical abilities, and quality of life. Patients in each group reported
- Fewer symptoms of depression and anxiety
- Improvements in quality of life related to mental health and some problem-solving skills
Who was in the study?
The study included 259 Latinx patients age 50 or older with symptoms of depression. Of these, 92 percent preferred speaking Spanish. The average age was 70, and 78 percent were women. All patients went to clinics that care for older patients with more than one health problem in the Los Angeles, California area.
What did the research team do?
The research team assigned patients to Programa Esperanza or depression education by chance. Patients responded to a survey when the study began and again after 3, 6, and 12 months. The team asked patients about symptoms of depression and anxiety, quality of life, and problem-solving skills.
Patients, case managers, and other healthcare professionals gave input to the research team during the study.
What were the limits of the study?
The research team didn’t compare patients in the two study groups with a group who received only usual care. So, the improvements in depression and anxiety seen in the study could be a result of the programs or something else. Clinic staff and patients may have shared information from Programa Esperanza with patients who had depression education. If so, it would be hard to detect differences between the two groups. All patients were Latinx adults living in California, and most spoke Spanish. Results may differ for patients of other backgrounds.
Future researchers could design a study that would prevent information sharing across groups and include a group without treatment. Studies could also test if the patient improvements last longer than one year.
How can people use the results?
Health clinics that treat Latinx patients age 50 or older can use these results when considering ways to help patients with depression.
Professional Abstract
Objective
To compare the effectiveness of a culturally modified problem-solving intervention with depression education in reducing severity of depression for Latinx patients age 50 or older
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 259 Latinx adults age 50 or older with symptoms of depression |
| Interventions/ Comparators |
|
| Outcomes |
Primary: depression Secondary: anxiety, chronic low-level depression, problem-solving abilities, physical function, mental and physical health QOL |
| Timeframe | 1-year follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of a short-term intervention called Programa Esperanza with single-session depression education in reducing severity of depression among Latinx patients age 50 or older. Patients participating in Programa Esperanza learned about their mental health and learned strategies for problem-solving and for feeling better during eight weekly one-on-one sessions lasting about an hour each. In addition, they received handouts and homework. Three monthly 15-minute booster sessions followed the weekly sessions. Patients getting depression education received a single, one-hour, one-on-one educational session and handouts about depression symptoms and treatment options.
Trained bilingual staff without professional training in counseling led the sessions for both groups. Each group continued to receive routine primary care services, which included referral to mental health services as needed.
The study included 259 patients who had screened positive for at least mild depression, and 74% had moderate to severe depression. All patients in the study were Latinx, age 50 or older, had multiple medical conditions, and were receiving all-inclusive care at a program for the elderly in Los Angeles County, California. Of these patients, 78% were female, and 92% preferred speaking Spanish. The average age was 70.
The research team surveyed patients in person at baseline and then 3, 6, and 12 months later to assess outcomes. Of the patients in the study, 95% completed the last interview at 12 months.
Patients, case managers, and healthcare providers provided input to the research team throughout the study.
Results
At the end of the study, each group showed significant improvement in depression scores (p<0.0001). However, the two groups did not differ significantly in depression severity at any time during the study.
Measures of anxiety, ongoing low-level depression, problem-solving abilities, physical function, and mental and physical health quality of life (QOL) also did not differ significantly between the two groups over the course of the study. Patients in both groups showed significant improvement by the end of the study in anxiety (p=0.04 and p=0.0002 for Programa Esperanza and depression education, respectively) and mental health QOL (p=0.05 and p=0.008, respectively) as well as in some specific measures of problem-solving abilities. Chronic low-level depression and physical health QOL showed no significant improvement over time in either group.
Limitations
Without a no-treatment comparison, this study cannot establish with certainty that the changes from before to after the interventions resulted from those interventions. Patients or staff may have shared information across groups, which would make it more difficult to detect differences between the two groups. All patients were Latinx adults living in California, and most spoke Spanish primarily; results may differ for patients of other backgrounds.
Conclusions and Relevance
In this study, Programa Esperanza and depression education were equally effective in improving depression and other outcomes for Latinx patients age 50 or older.
Future Research Needs
In the future, researchers could include a no-treatment group, prevent information sharing across groups, and examine intervention effects over a longer time period.
Final Research Report
View this project's final research report.
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- The reviewers requested additional details on the qualitative methods used, specifically asking that the questionnaires used in the study be included in the report along with an explanation of how the researchers developed. The researchers expanded their description of the qualitative methods they used and expanded the results section to include representative quotes. However, they said that those who would like to see the questionnaires can request them from the first author.
- The reviewers asked for more detailed information on the two interventions used. The researchers expanded their description of the interventions and clarified the differences between them. The researchers added a web link for information on Problem Solving Treatment (PST).
- The reviewers suggested that beyond depression, the study could have more appropriately evaluated whether PST improved problem-solving skills. The researchers noted that the primary objective of PST is depression treatment, so depression was their primary outcome. However, their secondary outcomes did measure problem-solving skills, and the researchers indicated that future post-hoc analyses would look at associations between social problem solving and depression outcomes.
- The reviewers suggested subgroup analysis, stating that it would be interesting to show whether factors like social support or living alone related to outcomes. The researchers said the idea is intriguing. The study was limited to reporting analyses defined from the outset of the project, but the researchers said they will look further into the data collected for such analyses. They added that preliminary analyses suggest no subgroup differences based on how long people had lived in the United States or based on social support or living arrangements.