We describe a theoretically grounded and empirically developed intervention for depression with older men in a state reformatory nursing home. As the number of prisoners “aging in place” rises, there is a critical need for research on mental health interventions in prison nursing homes where inmates may be at high risk for depression and suicide. The participants in this project were four male residents in the Kentucky state prison system nursing home; all four had diagnoses of major depressive episodes. BE-ACTIV, a behavioral treatment for depression, is a hybrid approach that combines one-to-one sessions with the depressed resident and work with staff. One-to-one sessions motivate the resident to engage in new activities, while meetings with nursing home staff break down barriers to completion of pleasant events. Over the 10-week treatment, depressive symptoms declined, and global functioning increased an average of 13 points per participant. Two of the participants showed improved self-reported negative affect. Study results suggest that BE-ACTIV is feasible in the prison nursing home and has the potential to improve the quality of life for medically frail prisoners by helping them to identify meaningful or pleasant activities. The cases illustrate importance of therapeutic relationships in the context of improving depressive symptoms, and the possibility of building effective relationships in a setting with multiple barriers to effective treatment.
Aday, R. (1994). Golden years behind bars: Special programs and facilities for elderly inmates [Electronic version]. Federal Probation, 58(2), 47.
2.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author .
3.
Baillargeon, J., Black, S.A., Contreras, S., Grady, J., & Pulvino, J. (2002). Anti-depressant prescribing patterns among prison inmates with depressive disorders. U.S. Department of Justice Document #194054. Retrieved January 16, 2008, from the National Criminal Justice Reference Service Web site: http://www.ncjrs.gov/pdffiles1/nij/grants/194054.pdf
Bureau of Justice Statistics. (2003). Census of state and federal correctional facilities, 2000. Revised 2003. Retrieved January 16, 2008, from http://www.ojp.usdoj.gov/bjs/pub/pdf/csfcf00.pdf
Fazel, S., Hope, T., O'Donnell, I., & Jacoby, R. (2001). Hidden psychiatric morbidity in elderly prisoners [Electronic version]. British Journal of Psychiatry, 179, 535-539.
8.
Fazel, S., Hope, T., O'Donnell, I., & Jacoby, R. (2004). Unmet treatment needs of older prisoners: A primary care survey. Age and Ageing, 33, 396-398.
9.
Fazel, S., & Lubbe, S. (2005). Prevalence and characteristics of mental disorders in jails and prisons. Current Opinion in Psychiatry, 18, 550-554.
10.
First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B.W. (2002, November). Structured Clinical Interview for DSM-IV-TR Axis I disorders, research version, patient edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.
11.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). "Mini-mental state": A practical method for grading the cognitive state of patients for the clinician . Journal of Psychiatry Research, 12, 189-198.
12.
Goetting, A. (1983). The elderly in prison. Journal of Research in Crime and Delinquency, 20, 291-309.
13.
James, D.J., & Glaze, L.E. (2006). Mental health problems of prison and jail inmates . U. S. Department of Justice, Bureau of Justice Statistics , NCJ 213600, September. Retrieved January 16, 2008, from http://www.ojp.usdoj.gov/bjs/pub/pdf/mhppji.pdf
14.
Konrad, N., Daigle, M.S., Daniel, A.E., Dear, G.E., Frottier. P., Hayes, L.M., et al. (2007). Preventing suicide in prisons, Part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons. Crisis, 28, 113-131.
15.
Lawton, M.P. (1997). Positive and negative affective states among older people in long-term care. In R. L. Rubinstein & M. P. Lawton (Eds.), Depression in long-term and residential care (pp. 29-54). New York: Springer.
16.
Lawton, M.P., Kleban, M.H., Dean, J., Rajagopal, D., & Parmelee, P.A. (1992). The factorial generality of brief positive and negative affect measures. Journal of Gerontology: Psychological Sciences, 47, 228-237.
17.
Lewinsohn, P.M., Hoberman, H., Teri, L., & Hautzinger, M. (1985). An integrative theory of depression. In S. Reiss & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 331-359). New York: Academic Press.
18.
Meeks, S., & Burton, E.G. (2004). Nursing home staff characteristics and knowledge gain from a didactic workshop on depression and behavior management. Gerontology and Geriatrics Education, 25, 57-66.
19.
Meeks, S., & Depp, C.A. (2002). Pleasant-events based behavioral intervention for depression in nursing home residents: A conceptual and empirical foundation . Clinical Gerontologist, 25, 125-148.
20.
Meeks, S., Heuerman, A., Ramsey, S., Welsh, D., & White, K. (2005, November). The Pleasant Events Scale-Nursing Home Version: Development and validation. Paper presented at the Annual Meeting of theGerontological Society of America, Orlando, FL.
21.
Meeks, S., Looney, S.W., Van Haitsma, K., & Teri, L. (2008). BE-ACTIV: A staff-assisted, behavioral intervention for depression in nursing homes. The Gerontologist, 48, 105-114.
22.
Meeks, S., Teri, L., Van Haitsma, K., & Looney, S.W. (2006). Increasing pleasant events in the nursing home: Collaborative behavioral treatment for depression. Clinical Case Studies, 5, 287-304.
23.
Nelson, E.C., Wasson, J., Johnson, D.J., & Hays, R.D. (n.d.). Dartmouth COOP functional health assessment charts: Brief measures for clinical practice. Retrieved June 16, 2005, from the Dartmouth University COOP Project Web site: http://www.dartmouth.edu/~coopproj/more_charts.html
24.
Nelson, E.C., Wasson, J., Kirk, J., Keller, A., Clark, D., Dietrich, A., et al. (1987). Assessment of function in routine clinical practice: Description of the COOP chart method and preliminary findings. Journal of Chronic Diseases, 40, 55S-63S.
25.
National Institutes of Health. (2007). Re-engineering the clinical research enterprise. Retrieved January 9, 2008, from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp
26.
Pollock, P. H.,Stowell-Smith, M., & Göpfert, M. (Eds.). (2006). Cognitive analytic therapy for offenders. London: Routledge.
27.
Saunders, J. W. (Ed.). (2001). Life within hidden worlds. Psychotherapy in prisons. London : Karnac Books.
28.
Senior, J., Hayes, A.J., Pratt, D., Thomas, S.D., Fahy, T., Leese, M., et al. (2007). The identification and management of suicide risk in local prisons. Journal of Forensic Psychiatry and Psychology, 18, 368-380.
29.
Teri, L. (1994). Behavioral treatment of depression in patients with dementia. Alzheimer's Disease and Associated Disorders , 8, 66-74.
30.
Teri, L. (1997). The relation between research on depression and a treatment program: One model. In R. L. Rubinstein & M. P. Lawton (Eds.), Depression in long-term and residential care (pp. 129-153). New York: Springer.
31.
Teri, L., Logsdon, R., & Uomoto, J. (1991). Treatment of depression in patients with Alzheimer's disease. Therapist Manual. Seattle: University of Washington School of Medicine.
32.
Teri, L., Logsdon, R.G., Uomoto, J., & McCurry, S.M. (1997). Behavioral treatment of depression in dementia patients: A controlled clinical trial. Journal of Gerontology: Psychological Sciences, 52B, P159-P166.
33.
Vernig, P.M. (2007). From science to practice: Bridging the gap with translational research. APS Observer, 20(2). Retrieved January 19, 2008, from http://www.psychologicalscience.org/observer/getArticle.cfm?id=2133
