Forrest R. Scogin - US grants

DESCRIPTION (adapted from investigator's abstract): This is a resubmission of a previously reviewed project. Older rural home health care recipients are a group overlooked in gerontological research. These persons experience significant problems with emotional well-being and decrements in quality of life that are not being adequately addressed by existing resources. The present study will investigate the effectiveness of a psychosocial intervention for improving the quality of life of these frail and sick elders. The treatment will be delivered in the homes of the care recipients and the primary family caregiver will participate in the therapy as a facilitator. Improved quality of life and emotional well being should result in the care recipient's reduced use of health care services. Aim 1 of the study is to test the efficacy of a brief, in-home psychosocial treatment in improving thew quality of life of rural home health care recipients. The treatment will be delivered by clinical social workers and will entail the provision of 16 sessions of cognitive-behavioral therapy. Family caregivers will attend therapy sessions and will facilitate the therapy by providing reminders, prompts and assistance to the care recipients in implementing therapeutic tasks. A delayed treatment control group design will be used to evaluate effectiveness of the treatment package on measured quality of life and emotional well-being. The investigators will also assess whether teaching problem solving skills and using the caregiver as treatment facilitator has a positive effect on such factors as caregiver burden and the caregiver care recipient relationship. Aim 2 of the study is to assess the effects of the intervention on the home health care recipient's use of home health care services. The conceptual framework on which the intervention is based posits that improvements in quality of life and emotional well being will mediate decreases in health care use. This model will be empirically evaluated through the assessment data collected in this study. Aim 3 is to investigate the success of efforts to make the intervention responsive to white and African-American home care recipients. One-half of the participants, as well as half of our therapists and research assistants, will be African-American. It is expected that there will be no differences in the effectiveness of the intervention among African-Americans and white participants. The research team is interdisciplinary and includes two clinical geropsychologists, a doctoral level clinical social worker, a nurse scientist (Ph.D.) and a geriatrician. The investigators have prior experience, publications, and preliminary data on the implementation of treatment protocols with older adults, community caregivers, and rural dwelling home health care recipients.

DESCRIPTION (provided by applicant): Insomnia and depression are two of the most prevalent mental health disorders and often co-occur. Health disparities in rural America and among African-Americans are well documented. We propose an R34 exploratory project to test the feasibility of delivering high-fidelity insomnia and depression psychological services to an underserved population. Treatment of Insomnia and Depression in Elders (TIDE) is a pilot study that will treat rural, predominantly African-American older adults who present to their primary care physician with co-occurring insomnia/depression. Stage 1 will be an uncontrolled case study series (n = 10) focusing on treatment development/refinement and patient acceptability. In stage 2, feasibility will be experimentally tested with 46 participants randomized to integrated cognitive-behavior therapy (CBT) + usual care or to usual care only in an effectiveness pilot study. The treatment will combine/integrate compact CBT for insomnia (including relaxation, sleep restriction, and stimulus control) and for depression (including cognitive therapy and behavioral activation). The experimental intervention comprises delivering CBT services by videoconferencing to patients in primary care settings who live in rural areas. Treatment will be evaluated by pre, post, and follow-up self report instruments on insomnia, depression, and quality of life. In addition, the stage 1 pilot will use investigator designed quantitative and qualitative measures to evaluate critical process variables including patient acceptability of the video format, patient acceptability of the treatments, and obstacles to adherence. Depending on stage 1 data, these measures may be incorporated into stage 2 as well. Several innovative features of this exploratory project include: intervening with CBT on both disorders hoping to gain a synergy by their combined presentation;use of telehealth to deliver treatment to distant locations;translation of efficacy findings to an effectiveness trial;treatment will be delivered in the primary care setting, the preferred locale of rural, older adults;the study will extend knowledge of the range of CBT applications by enrolling under-represented groups with respect to ethnicity, literacy, and financial resources. The primary aims of this project are (1) to determine the feasibility and maximal therapy characteristics of integrated CBT for co-occurring insomnia/depression in both the case study series (stage 1) and the experimental investigation (stage 2), (2) collect pilot data on whether participants receiving integrated CBT + usual care show comparable or greater reductions in insomnia symptoms compared to participants receiving usual care at posttreatment and follow-up, and (3) collect pilot data on whether participants receiving integrated CBT + usual care show comparable or greater reductions in depression symptoms compared to participants receiving usual care at posttreatment and follow-up. PUBLIC HEALTH RELEVANCE: Co-occurring insomnia and depression is a highly prevalent mental health disorder. This combination is well represented in groups characterized by health disparities: rural, African-Americans. We propose an R34 exploratory project to test the feasibility of delivering high-fidelity insomnia and depression psychological services to these underserved populations.