Tuesday, April 23, 2024

Peer-Supported Problem-Solving May Help Older Rural Adults With Depression

Older adults who completed 12 weeks of self-guided problem-solving therapy (PST) supported by trained peer volunteers had significant and lasting improvements in their depression scores, according to a report in Psychiatric Services in Advance. PST is a psychotherapy that teaches people to generate realistic solutions to life problems that contribute to depression.

“PST with a clinician should be considered a preferred treatment option when resources are available,” wrote Brooke Hollister, Ph.D., at the University of California, San Francisco, and colleagues. However, self-guided-PST supported by trained peer counselors “may be an appropriate and acceptable alternative to [clinician-managed]-PST (or other evidence-based interventions) for older adults who live in rural areas and experience barriers to access because of stigma, poor transportation options, or a lack of available clinicians and services.”

A total of 105 rural Californians aged 60 or older who had moderate to severe unipolar depression but did not have psychotic depression, a high suicide risk, or other major psychiatric disorders participated in the study. Eighty-five participants received clinician-managed PST with specially trained master’s level therapists or social workers, while the remaining 20 embarked on self-guided PST supported by peers who had also received special training. Both groups completed the PST sessions in their homes.

Depression levels were assessed with the Hamilton Depression Rating Scale [HAM-D]. Improvements in depression were clinically significant in both groups after 12 weeks, though clinician-managed PST did lead to higher response, remission, and retention rates, the researchers reported. Still, 45% of the adults in the peer-supported, self-guided group showed a treatment response of at least 50% reduction in HAM-D scores by week 12.

At 24 weeks, the groups equalized as the rates of depression reported by the self-guided group continued to drop, while the clinician-managed group’s depression scores rose slightly. This finding might imply a longer-lasting impact of self-guided treatment, given its focus on empowering patients to address their own problems, the researchers wrote. However, because the completion rate was lower for this group, Hollister and colleagues recommended further research to explore why.

“Effective use of [trained peer counselors] to support evidence-based treatments has the potential to maintain the independence of rural older adults by improving their access to mental health services and using existing infrastructure and minimal community resources,” they concluded.

For related information, see the Psychiatric Services article “Opportunities and Challenges to Build Behavioral Health Crisis Capacity in Rural America,” also published today.

(Image: Getty Images/iStock/KatarzynaBialasiewicz)

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