A randomized trial of depression assessment intervention in home health care Article

Bruce, ML, Brown, EL, Raue, PJ et al. (2007). A randomized trial of depression assessment intervention in home health care . JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 55(11), 1793-1800. 10.1111/j.1532-5415.2007.01419.x

cited authors

  • Bruce, ML; Brown, EL; Raue, PJ; Mlodzianowski, AE; Meyers, BS; Leon, AC; Heo, M; Byers, AL; Greenberg, RL; Rinder, S; Katt, W; Nassisi, P

authors

abstract

  • OBJECTIVES: To determine whether an educational intervention would improve depression assessment and appropriate referral. Secondary analyses tested whether referral led to depression improvement. DESIGN: Training in the Assessment of Depression (TRIAD) was a three-group, nurse-randomized trial. Researchers interviewed randomly selected patients at baseline and 8 weeks. SETTING: Three certified home healthcare agencies in Westchester County, New York. PARTICIPANTS: Fifty-three medical/surgical nurses were randomized within agency to three intervention groups: full, minimal, or control. Research contact with nurses' patients (aged >65; N=477) yielded 256 (53.7%) enrolled subjects, 84 (17.6%) ineligibles, and 120 (25.2%) refusals; 233 of the 256 (87.1%) enrolled patients completed follow-up interviews. INTERVENTION: Nurse training in clinically meaningful use of depression sections of Medicare's mandatory Outcome and Assessment Information Set (OASIS). MEASUREMENTS: Nurse-assessed mood or anhedonia (OASIS) versus research assessments using the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Disorders (SCID); referrals for mental health evaluation (agency records), and depression severity (24-item Hamilton Depression Rating Scale; HDRS). RESULTS: Referral rates for patients with (SCID) depressed mood or anhedonia (n=75) varied according to nurse group: 50.0% full intervention, 18.5% minimal, 21.4% control (P=.047). Rates for nondepressed patients (n=180) did not differ (4.9%, 2.0%, 5.8%, respectively; P=.60). In patients with major or minor depression (n=37), referral was associated with symptom improvement. Change in HDRS was 5 points greater in referred patients than others (P=.04). Concordance between OASIS and SCID did not differ between intervention groups. CONCLUSION: TRIAD showed that training nurses to assess for depression using an approach developed in partnership with home healthcare agencies led to appropriate referral and care for depressed patients. © 2007, The American Geriatrics Society.

publication date

  • November 1, 2007

published in

Digital Object Identifier (DOI)

start page

  • 1793

end page

  • 1800

volume

  • 55

issue

  • 11