Trajectories of Response to PROTECT, a community-based treatment for elder abuse victims with depression

Abstract

<h3>Introduction</h3> Elder abuse afflicts up to 10% of adults 60 years and older, with approximately one third of elder abuse (EA) victims presenting clinically significant depressive symptoms. When offered EA resolution services, victims underutilize them. In collaboration with community partners, we developed PROTECT, <i>Providing Options to Elderly Clients Together</i>, a brief behavioral psychotherapy for late-life depression among elder abuse victims. PROTECT aims to reduce depression and stress and increase sense of agency and capacity to utilize EA services (Sirey et al. 2021). In a recent expand of PROTECT delivery, we implemented the intervention in collaboration with five New York City elder abuse agencies over three years. We aimed to: a) examine the trajectories of response to PROTECT in a large community sample; b) identify predictors of treatment response in this sample. <h3>Methods</h3> A total of 179 elder abuse victims received PROTECT between 2018 and 2021. PHQ9 scores were collected at every visit during the weekly 9- week treatment. Latent Growth Mixture Modelling (LGMM) was used to derive separate latent trajectories of PHQ9 scores over time. LGMMs were constructed for two trajectories for both linear and quadratic time. The final model was chosen based on a combination of smallest Bayesian information criterion (BIC) and clinical plausibility. Participant characteristics were compared between classes through Chi-squared/Fisher's Exact tests or independent two-sample t-tests/Wilcoxon rank-sum tests. Linear mixed effects models were then used to estimate changes of PHQ9 over 10 weeks for each class. We stratified the data based on group class to obtain a separate coefficient for every trajectory. <h3>Results</h3> The sample comprised of 179 patients, with the majority of patients undergoing current abuse (70%). The mean PHQ9 of the total sample at baseline was 11.7 (std=5.1). PROTECT resulted in an average reduction in PHQ9 of 4.9 (std=4.7) and 53% of patients achieved a clinically relevant reduction in depression severity (PHQ9 reduction of 5 points or more). There was no association between demographic characteristics or type and number of abuse and treatment response. A two-group linear trajectory model was chosen based on minimal BIC and clinical plausibility to examine the relative response based on initial depression severity. Group-based trajectories differed by baseline severity of PHQ9 scores (mean PHQ9 of 9.6 and 17 for each group, respectively). The trajectories showed similar improvement from treatment for each group, suggesting that treatment is effective for all patients regardless of their baseline PHQ scores (mean improvement in PHQ9 was 9.6 > 5.1 and 17 > 11.7 for high baseline and low baseline severity groups, respectively). <h3>Conclusions</h3> PROTECT is effective in reducing depression severity among elder abuse victims. Importantly, PROTECT showed to be effective regardless of demographic differences, type and number of abuse or depression severity at baseline. These results are encouraging, as PROTECT is designed as a community-based intervention for elder abuse victims of diverse backgrounds and abuse histories. <h3>This research was funded by</h3> This project is funded by a contract from the NYC Department for the Aging (#20191406829, PI: Sirey). Dr. Solomonov is supported by a grant from the National Institute of Mental Health K23 MH123864