A NOVEL MODEL FOR LATE-LIFE DEPRESSION INTERVENTION DEVELOPMENT: Session 312

Abstract

We will present a novel model of deployment-based behavioral interventions and implementation, streamlined based on neurobiology models and augmented by mobile technology. Our model: 1) Develops its interventions jointly with community partners and a transdisciplinary team; 2) uses neurobiological concepts as a “simplification rule” for streamlining behavioral interventions so that they can be used by community clinicians; 3) integrates mobile technology to community interventions at the assessment, the intervention, and the adherence monitoring levels; and 4) tests its interventions at community sites using community clinicians to shorten the way to uptake and sustainability. To maximize our impact, we work both in settings in which most older and middle-aged people receive care (primary care) and in settings serving persons with special clinical (elder mistreatment) and social needs (poverty). Dr. Alexopoulos will discuss the rationale for developing this model and highlight how neurobiological findings can be used to streamline behavioral intervention so that they can be accurately used by community-based clinicians and sustained in community-based settings. The rest of presenters will discuss three interventions based on this model. Dr. Marino will present REDS (Reaching and Engaging Depressed Senior Center Clients), a community care model for senior center clients. More than 10,000 senior centers operate in the US and serve 1.25 million persons nationwide. Most have low income, and in NY City, 68% are non-Caucasian. About 10% have clinically significant depression but most receive no care. The Weill Cornell Institute of Geriatric Psychiatry has partnered with the NY City Department for the Aging to develop Reaching and Engaging Depressed Senior Center Clients (REDS). REDS relies on SMART-MH, a community care model, embedded in senior centers to improve recognition of depression, referral, and adherence to depression treatment. The REDS intervention is been administered in a group-format by licensed social workers in NYC senior centers. REDS is based on Engage, a stepped-care therapy, streamlined based on the assumption that a dysfunction of the reward network is central to the pathogenesis of depression and uses “reward exposure” as its principal intervention. If patients fail to engage in activities leading to “reward exposure”, therapists seek to identify and address barriers to reward exposure originating from other network dysfunctions (e.g. negativity bias, apathy, or emotional dysregulation) so that “reward exposure” can proceed unimpeded. Dr. Kiosses will present the theory and data on the implementation of “Relief”, a 9-session behavioral intervention for depression and chronic pain in primary care designed to be administered by licensed social workers and nurse practitioners in primary care practices. Chronic pain and depression frequently co-exist in late and mid-life and contribute to increased disability, care costs, psychiatric comorbidity, and suicide. Older and middle-aged depressed-pain patients are mainly treated in primary care practices and often receive opioids and benzodiazepines. Relief assumes that chronic pain and depression are characterized by an attentional bias assigning greater salience to interoceptive stimuli and to negative emotions along with difficulty shifting attention to a goal-oriented/reward-driven state, leading to inadequate engagement of the reward networks. Accordingly, Relief aims to shift patient attention away from pain and negative feelings and to increase their focus on pleasurable activities. Relief also assesses patient views of pain treatment (which may be adversely affected by depression), corrects unrealistic expectations, and helps to enhance patient-physician communication Dr. Sirey will discuss, EM/PROTECT, a behavioral intervention for depressed older mistreatment victims. Up to 10% of adults 60 years and older are victims of mistreatment. Approximately 1/3 of victims have clinically significant depressive symptoms. Depressed victims are less likely to utilize services to ameliorate the mistreatment and have higher mortality rates. We have developed a brief 9 session, behavioral intervention for depressed EM victims. EM/PROTECT is based on a model which postulates that chronic stress promotes dysfunction of the cognitive control (CCN) and reward networks, impairing the victims’ ability to flexibly respond to the environment and limits their rewarding activities. PROTECT therapists work with victims to develop action plans to reduce stress, and to increase rewarding experiences. The intervention is designed to work in synergy with EM mistreatment resolution services that provide safety planning, support services, and links to legal services. In this symposium, Dr. Sirey will describe the development of EM/PROTECT and its integration into elder abuse services in collaboration with the NYC Department for the Aging.