Effectiveness of Case Management with Problem-Solving Therapy for Rural Older Adults with Depression

Brooke Hollister,Rebecca Crabb,Sandi Kaplan,Matthew Brandner,Patricia Areán

doi:10.1016/j.jagp.2022.03.001

Brooke Hollister, Rebecca Crabb + Show 3 more

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https://doi.org/10.1016/j.jagp.2022.03.001

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Abstract

ObjectiveTo evaluate the effect of case management with problem solving therapy (CM-PST) on depression and disability among rural older adults and compare its effect with outcomes derived from a previous, but similar study among 84 urban older adults. MethodsThis study examined the comparative effectiveness of a CM-PST intervention for older adults with depression and unmet needs across rural and urban settings. Participants received 12 one-hour sessions of CM-PST with a master's-level clinician. A total of 56 rural and 84 urban adults aged 60 and older experiencing mild to moderate depression received services in their homes. ResultsThe rural CM-PST intervention resulted in significantly reduced depression (reduction of 13.9 points, 95% CI 12.2 to 15.7, t(422)= 15.35, p<0.0001) and disability by week 12 (reduction of 6.7 points, 95% CI 4.8 to 8.5, t(425)= 7.01, p<0.0001). Reductions in depression and disability were sustained through week 24. The reductions in depression (F=3.98 df=4,388. p=0.0035) and disability (F=2.71, df=4,381, p=0.03) found in the rural sample were comparable to, or better than, those found in the urban sample. Improvements in unmet need and resilience predicted lower depression scores at 12 weeks, while improvements in unmet need and hopelessness predicted improvements in disability. No moderators of depression were identified, but baseline values of self-efficacy, resilience, and hopelessness moderated disability. ConclusionsCM-PST was as effective at reducing depression and disability among rural older adults as it was for urban older adults. Home-delivered CM-PST can be successfully adapted to meet the specific needs of rural seniors using resources often available in rural communities.

Highlights

What is the meaning of the finding? This study shows that implementing case management with problem solving therapy (CM-PST) for older adults with depression in a rural location is both feasible and effective
It is possible that the 12 weeks of CMPST were more effective at addressing the lower number of unmet needs or lower depression severity found in the rural sample than the higher levels found in the urban sample
CM-PST in a rural location was shown to be as effective as CM-PST in an urban location on improving depression and reducing disability, despite the additional disparities and challenges to accessing services faced by rural older adults

Summary

Introduction

D epressive disorders are common among older adults, with prevalence slightly higher in rural populations than urban populations, though the significance of these differences varies in the literature.[1-3]. Compared to older adults in urban communities, rural older adults have higher rates of isolation,[5] chronic medical illness,[6] depression[2]; experience greater difficulty accessing transportation services[7]; and are subject to minimal service infrastructure.[8,9]. Rural older adults experience many of the risk factors associated with poor response to antidepressant medications, including: social isolation, limited financial resources, and barriers to care.[5,8,9,16]. Rural older adults are more likely to experience stigma, both public and internalized, about mental health problems, reducing helpseeking behavior.[18]. Despite these disparities, rural older adults report high levels of resilience,[19] a personal characteristic akin to self-reliance that is strongly associated with perceived mental health status.[20].

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