Peer Companionship for Mental Health of Older Adults in Primary Care: A Pragmatic, Non-Blinded, Parallel-Group, Randomised Controlled Trial

Abstract

Background: Social disconnectedness is associated with suicide in later life. We investigated whether peer companionship delivered by a community aging services agency to socially-disconnected older adult primary care patients was associated with improvement in suicidal ideation depression, anxiety, and psychological connectedness. Methods: Subjects recruited from primary care were enrolled in a 12-month, non-blinded, randomised controlled trial comparing a peer companion intervention, The Senior Connection (TSC), to care as usual (CAU). TSC was delivered by volunteers who provided supportive visits and phone calls.Data were collected at baseline, 3-, 6-, and 12-months. The primary outcome was suicidal ideation as measured by the Geriatric Suicide Ideation Scale; secondary outcomes were measures of depression, anxiety, and feelings of belonging and being a burden on others. Of 369 subjects randomised, 58 were lost to follow up and 56 others lacked 12-month outcome data because the study ended before they completed full participation. Intent-to-treat analyses with all 369 subjects used weighted generalized estimating equations to address all sources of missing data. Findings: Subjects (55% female) had a mean age of 71 years. There was no difference between groups in change in suicidal ideation or belonging. Subjects randomised to TSC had greater reduction in depression (PHQ-9; 2·33 point reduction for TSC vs. 1·32 for CAU, p= 0·05), anxiety (GAD-7; TSC 1·52 vs. CAU 0·28, p= 0·03), and perceived burden on others (INQ; 0·46 TSC vs. 0·09 CAU, p< 0·01). Interpretation: TSC was superior to CAU for improving depression, anxiety, and perceived burden, but not suicidal ideation. Although effect sizes were small, the low-cost and nationwide availability of peer companionship justify more research to examine its effectiveness and scalability in improving mental health outcomes of socially disconnected older adults. Trial Registration: TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01408654 Funding Statement: The U.S. Centers for Disease Control and Prevention and the National Institutes of Health. Primary support for the study was provided through a cooperative agreement between the grantees and CDC (U01CE001942) Declaration of Interests: Dr. Stone and Ms. McIntosh were employees of the Center for Disease Control and Prevention, which funded the study. Drs. Conwell, Tu, and Van Orden receive funding from the U.S National Institutes of Health for research unrelated to this study. Dr. Conwell has received support from the Office of the Attorney General of Canada for expert consultation on late life suicide. None of the authors have conflicts of interest to disclose, currently or in the last three years, including specific financial interests and relationships and affiliations relevant to the subject of this manuscript. Ethics Approval Statement: The University of Rochester Research Subjects Review Board approved all procedures and all subjects provided written informed consent after the procedures had been fully explained. Prior approval for the study was obtained from the GR-PBRN executive committee.