A Randomized Trial of Depression Assessment Intervention in Home Health Care

Authors

  • Martha L. Bruce PhD, MPH,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Ellen L. Brown RN, EdD,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Patrick J. Raue PhD,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Amy E. Mlodzianowski MS, LMSW,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Barnett S. Meyers MD,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Andrew C. Leon PhD,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Moonseong Heo PhD,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Amy L. Byers PhD, MPH,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Rebecca L. Greenberg MS,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Susan Rinder BSN,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Wendy Katt RN, MA, CS, NP,

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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  • Pamela Nassisi BSN, RN

    1. From the *Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New YorkStein Gerontological Institute, Miami, FloridaDominican Sisters Family Health Services, Ossining, New York§Visiting Nurse Association of Hudson Valley, Mount Kisco, New York; and Visiting Nurse Services in Westchester, White Plains, New York.
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Address correspondence to Martha L. Bruce, PhD, MPH, Professor of Sociology in Psychiatry, Weill Medical College of Cornell University, 21 Bloomingdale Road, White Plains, NY 10605.
E-mail: mbruce@med.cornell.edu

Abstract

OBJECTIVES: To determine whether an educational intervention would improve depression assessment and appropriate referral. Secondary analyses tested whether referral led to depression improvement.

DESIGN: Training in the Assessment of Depression (TRIAD) was a three-group, nurse-randomized trial. Researchers interviewed randomly selected patients at baseline and 8 weeks.

SETTING: Three certified home healthcare agencies in Westchester County, New York.

PARTICIPANTS: Fifty-three medical/surgical nurses were randomized within agency to three intervention groups: full, minimal, or control. Research contact with nurses' patients (aged >65; N=477) yielded 256 (53.7%) enrolled subjects, 84 (17.6%) ineligibles, and 120 (25.2%) refusals; 233 of the 256 (87.1%) enrolled patients completed follow-up interviews.

INTERVENTION: Nurse training in clinically meaningful use of depression sections of Medicare's mandatory Outcome and Assessment Information Set (OASIS).

MEASUREMENTS: Nurse-assessed mood or anhedonia (OASIS) versus research assessments using the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Disorders (SCID); referrals for mental health evaluation (agency records), and depression severity (24-item Hamilton Depression Rating Scale; HDRS).

RESULTS: Referral rates for patients with (SCID) depressed mood or anhedonia (n=75) varied according to nurse group: 50.0% full intervention, 18.5% minimal, 21.4% control (P=.047). Rates for nondepressed patients (n=180) did not differ (4.9%, 2.0%, 5.8%, respectively; P=.60). In patients with major or minor depression (n=37), referral was associated with symptom improvement. Change in HDRS was 5 points greater in referred patients than others (P=.04). Concordance between OASIS and SCID did not differ between intervention groups.

CONCLUSION: TRIAD showed that training nurses to assess for depression using an approach developed in partnership with home healthcare agencies led to appropriate referral and care for depressed patients.

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