Objective: Data are presented from a pilot research program initiated to develop, refine, and test the outcomes of problem-solving therapy that targets the needs of older adults with minor depression in home care settings. Method: A pilot randomized clinical trial compares the impact of problem-solving therapy for home care to treatment as usual in a sample of older, medically ill home care patients. Compared with 32 older home care participants randomized to the treatment as usual condition, 30 older home care participants in an intervention condition received brief problem-solving therapy. Results: Outcome data suggest significant improvements in depression symptomatology and problem-solving abilities after problem-solving therapy for home care, relative to treatment as usual. The experimental group was also more satisfied with treatment as compared to the control condition. Conclusion: Authors discuss results in terms of the “real-world” social work applicability of this psychosocial treatment for late-life depression.
Alexopoulos, G., Raue, P., & Arean, P. -2003-. Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. American Journal of Geriatric Psychiatry, 11, 46-52.
2.
American Psychiatric Association. -2000-. Diagnostic and statistical manual of mental disorders -4th ed., text rev.-. Washington, DC: Author.
3.
Arean, P.A., Perri, M.G., Nezu, A.M., Schein, R.L., Christopher, F., & Joseph, T.X. -1993-. Comparative effectiveness of social problem solving therapy and reminiscence therapy as treatments for depression in older adults . Journal of Consulting and Clinical Psychology, 61, 1003-1010.
4.
Banerjee, S., Shamash, K., Macdonald, A.J.D., & Mann, A.H. -1996-. Randomized controlled trial of effect of intervention by psychogeriatric team on depression in frail elderly people at home. British Medical Journal, 313, 1058-1061.
5.
Barrett, J., Williams, J., Oxman, T., Frank, E., Katon, W., Sullivan, M., et al. -2001-. Treatment of dysthymia and major depression in primary care: A randomized trial in patients aged 18-65. Journal of Family Practice, 50, 405-412.
6.
Bartels, S., Dums, A., Oxman, T., Schneider, L., Arean, P., Alexopoulos, G., et al. -2002-. Evidence-based practices in geriatric mental health care. Psychiatric Services, 53-11-, 1419-1431.
7.
Blazer, D. -2003-. Depression in late life: Review and commentary . Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 58, 249-265.
8.
Brown, E.L., McAvay, G.J., Raue, P.J., Moses, S., & Bruce, M.L. -2003-. Recognition of depression in the elderly receiving homecare services. Psychiatric Services, 54, 208-213.
9.
Bruce, M.L. -2001-. Depression and disability in late life: Directions for future research. American Journal of Geriatric Psychiatry , 9, 102-112.
10.
Bruce, M.L., McAvay, G.J., Raue, P.J., Brown, E.L., Meyers, B.S., Keohane, D.J., et al. -2002-. Major depression in elderly home health care patients. American Journal of Psychiatry, 159, 1367-1374.
11.
Cassidy, E., Baird, E., & Sheikh, J. -2001-. Recruitment and retention of elderly patients in clinical trials: Issues and strategies. American Journal of Geriatric Psychiatry, 9, 136-140.
12.
Catalan, J., Gath, D.H., Anastasiades, P., Bond, S.A., Dat, A., & Hall, L. -1991-. Evaluation of a brief psychological treatment for emotional disorders in primary care. Psychological Medicine , 21, 1013-1018.
13.
Chang, C., D'Zurilla, T.J., & Sanna, L. -2004-. Social problem solving: Theory, research, and training. Washington, DC: American Psychological Association.
14.
Conwell, Y., Duberstein, P., Conner, K., Eberly, S., Cox, C., & Caine, E. -2002-. Access to firearms and risk for suicide in middle-aged and older adults. American Journal of Geriatric Psychiatry , 10-4-, 407-416.
15.
DeRubeis, R.J., Gelfand, L.A., Tang, T.Z., & Simons, A.D. -1999-. Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons . American Journal of Psychiatry, 156, 1007-1013.
16.
Dixon, W. -2000-. Problem-solving appraisal and depression: Evidence for a recovery model. Journal of Counseling and Development , 78, 87-91.
17.
Doorenbos, A., Given, B., Given, C., Verbitsky, N., Cimprich, B., & McCorkle, R. -2005-. Reducing symptom limitations: A cognitive behavioral intervention randomized trial. Psycho-oncology, 14, 574-585.
18.
Dowrick, C., Dunn, G., Ayuso-Mateos, J., Dalgard, O., Page, H., Lehtinen, V., et al. -2000-. Problem solving treatment and group psychoeducation for depression: Multicenter randomized controlled trial. British Medical Journal, 321, 1450-1454.
19.
D'Zurilla, T.J., Chang, E.C., Nottingham, E.J., IV , & Faccini, L. -1998-. Social problem-solving deficits and hopelessness, depression, and suicidal risk in college students and psychiatric inpatients. Journal of Clinical Psychology , 54, 1-17.
20.
D'Zurilla, T.J., & Nezu, A.M. -1999-. Problem-solving therapy: A social competence approach to clinical intervention -2nd ed.-. New York: Springer.
21.
D'Zurilla, T.J., Nezu, A.M., & Maydeu-Olivares, T. -2002-. Social Problem-Solving Inventory Revised -SPSI-R-: Manual. North Tonawanda, NY : Multi-Health Systems.
22.
Elliott, T., Shewchuk, R., & Richards, J. -2001-. Family caregiver social problem-solving abilities and adjustment during the initial year of the caregiving role. Journal of Counseling Psychology, 48, 223-232.
23.
Folstein, M.F., Folstein, S.E., & McHugh, P. -1975-. "Mini-mental state": A practical method for grading the cognitive state of patients for the clinician . Journal of Psychiatry Research, 12, 189-198.
24.
Gellis, Z.D. -2006-. Mental and emotional problems in older adults . In B. Berkman -Ed.-, Handbook of social work in health and aging -pp. 129-139-. New York: Oxford University Press.
25.
Gellis, Z.D., & Kim, J. -2004, November-. Confirmatory factor analysis of the CES-D Short Form as a screening measure of depression in an elderly home health care population. Paper presented at the 57th Gerontological Society of America annual conference, Washington, DC.
26.
Gellis, Z.D., McGinty, J., Tierney, L., Jordan, C., Burton, J., Misener, E., & Bruce, M. -2005, November-. Homecare professional's recognition of depression and anxiety in older cardiac patients. Paper presented at the 58th annual Gerontological Society of America conference , Washington, DC.
27.
Gellis, Z.D., McGinty, J., & Misener, E. -2007, March-. Controlled trial of problem solving therapy for late life depression in home care. Paper presented at the annual meeting of the American Association for Geriatric Psychiatry , New Orleans, LA.
28.
Gellis, Z.D., McGinty, J., Tierney, L., Jordan, C., Burton, J., Misener, E., & Kim, J. -2004, November-. Depression screening in older medically ill home health care patients. Paper presented at the 57th annual Gerontological Society of America conference, Washington, DC.
29.
Grant, J.S., Elliott, T.R., Giger, J.N., & Bartolucci, A.A. -2001-. Social problem-solving abilities, social support, and adjustment among family caregivers of individuals with a stroke. Rehabilitative Psychology, 46, 44-57.
30.
Hamilton, M. -1967-. Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology , 6-4-, 278-296.
31.
Hegel, M., Barrett, J., & Oxman, T. -2000-. Training therapists in problem-solving treatment of depressive disorders in primary care: Lessons learned from the treatment effectiveness project. Families, Systems and Health, 18, 423-435.
32.
Horowitz, A., Reinhardt, J., & Kennedy, G. -2005-. Major and subthreshold depression among older adults seeking vision rehabilitation services. American Journal of Geriatric Psychiatry, 13, 180-187.
33.
Hybels, C., Blazer, D., & Pieper, C. -2001-. Toward a threshold for subthreshold depression: An analysis of correlates of depression by severity of symptoms using data from an elderly community sample. The Gerontologist, 41-3-, 357-365.
34.
Joiner, T., Voelz, Z., & Rudd, M. -2001-. For suicidal young adults with comorbid depressive and anxiety disorders, problem-solving treatment may be better than treatment as usual. Professional Psychology: Research and Practice, 32-3-, 278-282.
35.
Kant, G., D'Zurilla, T., & Maydeu-Olivares, A. -1997-. Social problem-solving as a mediator of stress-related depression and anxiety in middle-aged and elderly community residents. Cognitive Therapy and Research , 21, 73-96.
36.
Katon, W., Von Korff, M., Lin, E., Simon, G., Ludman, E., Russo, J., et al. -2004-. The pathways study: A randomized trial of collaborative care in patients with diabetes and depression. Archives of General Psychiatry, 61, 1042-1049.
37.
Kennedy, G. -2000-. Geriatric mental health care. New York: Guilford.
38.
Kohout, F.J., Berkman, L.F., Evans, D.A., Cornoni-Huntley, J. -1993-. Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5, 179-193.
39.
Lebowitz, B.D., Pearson, J.L., Schneider, L.S., Reynolds, C.F., Alexopoulow, G.S., Bruce, M.L., et al. -1997-. Diagnosis and treatment of depression in late life: Consensus statement update. Journal of the American Medical Association, 278, 1186-1190.
40.
Lyness, J.M., Caine, E.D., King, D.A., Conwell, Y., Duberstein, P.R., & Cox, C. -2002-. Depressive disorders and symptoms in older primary care patients: one-year outcomes. American Journal of Geriatric Psychiatry, 10, 275-282.
41.
MacPhillamy, D., & Lewinsohn, P. -1982-. The pleasant events schedule: Studies on reliability, validity, and scale intercorrelation. Journal of Consulting and Clinical Psychology, 50, 363-380.
42.
Marshall, G.N., Hays, R.D., Sherbourne, C.D., & Wells, K.B. -1994-. The structure of patient satisfaction with outpatient medical care. Psychological Assessment, 5, 477-483.
43.
McDowell, I. -2006-. Measuring health: A guide to rating scales and questionnaires -3rd ed.-. New York: Oxford University Press.
44.
Miner, R., & Dowd, E. -1996-. An empirical test of the problem solving model of depression and its application to the prediction of anxiety and anger. Counseling Psychology Quarterly, 9, 163-176.
45.
Mynors-Wallis, L. -1996-. Problem-solving treatment: Evidence for effectiveness and feasibility in primary care. International Journal of Psychiatry Medicine, 26, 249-262.
46.
Mynors-Wallis, L.M., Gath, D.H., Lloyd-Thomas, A.R. & Tomlinson, D. -1995-. Randomized controlled trial comparing problem-solving treatment with amitriptyline and placebo for major depression in primary care . British Medical Journal, 310, 441-445.
47.
Nezu, A. -2004-. Problem-solving and behavior therapy revisited . Behavior Therapy, 35, 1-33.
48.
Nezu, A.M., & D'Zurilla, T.J. -2001-. Problem-solving therapies . New York: Guilford.
49.
Nezu, A., Nezu, C., Felgoise, S., McClure, K., & Houts, P. -2003-. Project genesis: Assessing the effectiveness of problem-solving therapy for distressed adult cancer patients. Journal of Consulting and Clinical Psychology, 71, 1036-1048.
50.
Nezu, A.M., Nezu, C., & Perri, M. -1989-. Problem-solving therapy for depression: Theory, research and clinical guidelines. New York: John Wiley.
51.
Nezu, C., Nezu, A., Friedman, S., Houts, P., Dellicarpini, L., Bildner, C., & Faddis, S. -1999-. Cancer and psychological distress: Two investigations regarding the role of social problem-solving. Journal of Psychosocial Oncology, 16-3/4-, 27-40.
52.
Osborn, D.P.J., Fletcher, A.E., Smeeth, L., Stirling, S., Bulpitt, C.J., Nunes, M., et al. -2002-. Geriatric Depression Scale scores in a representative sample of 14545 people aged 75 and over in the United Kingdom: Results from the MRC trail of assessment and management of older people in the community. International Journal of Geriatric Psychiatry , 17, 375-382.
53.
Shapiro, D.A., Barkham, M., Rees, A., Hardy, G.E., Reynolds, S., & Startup, M. -1994-. Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psycho-dynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology , 52, 522-534.
54.
Spitzer, R., Williams, J., Kroenke, K., & Linzer, M. -1994-. Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. Journal of the American Medical Association, 272-22-, 1749-1756.
55.
Spitzer, W.O., Dobson, A.J., & Hall, J. -1981-. Measuring the quality of life of cancer patients: A concise QL-index for use by physicians. Journal of Chronic Disabilities, 34, 585-597.
56.
Stevens, J. -2002-. Applied multivariate statistics for the social sciences -4th ed.-. Hillsdale, NJ: Lawrence Erlbaum.
