A Randomized Trial of Depression Assessment Intervention in Home Health Care
Article first published online: 3 OCT 2007
Journal of the American Geriatrics Society
Volume 55, Issue 11, pages 1793–1800, November 2007
How to Cite
Bruce, M. L., Brown, E. L., Raue, P. J., Mlodzianowski, A. E., Meyers, B. S., Leon, A. C., Heo, M., Byers, A. L., Greenberg, R. L., Rinder, S., Katt, W. and Nassisi, P. (2007), A Randomized Trial of Depression Assessment Intervention in Home Health Care. Journal of the American Geriatrics Society, 55: 1793–1800. doi: 10.1111/j.1532-5415.2007.01419.x
- Issue published online: 29 OCT 2007
- Article first published online: 3 OCT 2007
- depression assessment;
- educational intervention;
- home health care;
- medical comorbidity
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.