Benefit and Uptake: A mixed methods study exploring older adults’ experiences with a psychoeducational and exercise training maintenance intervention

Abstract

Objectives:

Evaluate whether engaging in a combined psychoeducational and exercise-maintenance intervention was associated with the non-recurrence of psychological distress and mobility difficulties; explore participants’ perceived benefits; and identify factors associated with intervention uptake.

Design:

Convergent mixed-methods. Quantitative data included 48 participants from the maintenance phase (Months 7-12) of the Positive Minds Strong Bodies-Enhanced randomized trial, and 19 semi-structured interviews with participants who accepted or declined the intervention.

Setting:

Community-based organizations and clinics in four U.S. locations: Massachusetts, Maryland, New York, and Puerto Rico. Data was collected between November 2020 and October 2024.

Participants:

Older adults (60+) with mild-to-severe depression or anxiety symptoms and minor-to-moderate mobility difficulties.

Interventions:

Up to 24 psychoeducation and up to 48 exercise drop-in maintenance group sessions to sustain and enhance the benefits of the acute phase.

Measurements:

Recurrence of psychological distress and mobility difficulties at 12 months, using the Hopkins Symptom Check List-25 and the Short Physical Performance Battery. We also identified participant-level demographic and clinical characteristics associated with intervention uptake. We compared all measurements by intervention uptake (accepted vs declined).

Results:

There were no differences in the recurrence of psychological distress or mobility difficulties by intervention uptake (accepted vs declined). However, those who accepted described benefits in symptom relief and daily functioning. Several factors influenced uptake decisions: age, race/ethnicity, cognitive function, and participants’ appraisal of their individual and environmental needs.

Conclusions:

Older adults can reap benefits from maintenance interventions. However, their engagement hinges on alignment with personal, social, and environmental contexts.

Introduction

Recurring depression and anxiety in older adults pose a significant public health challenge, associated with declines in health, quality of life, and cognitive function.^1,2 Nearly 60% of older adults (≥60) experience depression recurrence within two years,³ and 33% experience anxiety recurrence within six months.⁴ Despite effective acute treatments, sustained recovery is complicated by physical and social health factors.^5,6 Physical function and mental illness have a bidirectional relationship,⁷ with physical declines both resulting from and precipitating recurrence. Thus, maintenance treatments targeting both physical and mental health may better sustain recovery. In this study, maintenance treatments are interventions delivered after the acute phase to sustain and enhance gains over the subsequent months.

In older adults, the evidence for maintenance treatments is limited, especially for multimodal, nonpharmacological approaches, including no studies on psychotherapy-only or psychotherapy combined with exercise.⁸ Nonetheless, encouraging findings on maintenance treatments combining psychotherapy with pharmacotherapy include reduced recurrence of depression⁹ and improved social adjustment.¹⁰ However, benefits vary by age,¹¹ cognitive function,¹² initial treatment response,¹³ and treatment focus.¹⁴

Furthermore, the generalizability of findings on combined maintenance treatments (psychotherapy and pharmacotherapy) is limited, since most studies were conducted in geropsychiatry clinics with racially homogeneous samples (93% White) and presumably only in English.⁸ It is unclear whether racially and ethnically diverse older adults would accept maintenance treatments. Studies on general mental health services show that clinical (e.g., symptom severity) and sociodemographic factors (e.g., race/ethnicity) influence engagement, suggesting these factors may also influence engagement in maintenance treatments.¹⁵ Thus, investigating the benefits and uptake of community-based maintenance treatments in diverse samples offers an opportunity to expand the generalizability of findings and reduce disparities in mental health care.

This study described findings from the maintenance phase of the Positive Minds Strong Bodies-Enhanced (PMSB-E) randomized trial.¹⁶ The PMSB-E trial aims to address the co-occurring challenges of mental illness and physical disability by combining a psychoeducational and exercise interventions in two phases: acute and maintenance.¹⁶

This study sought to (1) evaluate whether engaging in a maintenance intervention was associated with non-recurrence of psychological distress and mobility difficulties at 12 months (quantitative), (2) explore participants’ perceived benefits (qualitative), and (3) identify factors associated with intervention uptake (quantitative and qualitative). Findings could inform the development of effective, acceptable maintenance interventions to sustain long-term recovery in diverse populations.

Methods

Study Design

This study used a convergent mixed-methods design,¹⁷ involving separate collection and analysis of quantitative and qualitative data, followed by joint interpretation. We followed the Mixed Methods Article Reporting Standards of the American Psychological Association.¹⁸ The Mass General Brigham institutional review board approved study procedures, and participants provided informed consent.

Procedures

Quantitative data came from 48 participants randomized to the maintenance phase of the PMSB-E trial,¹⁶ who either accepted (n = 20) or declined (n = 28) to participate (Figure 1). Participants were enrolled between November 2020 and October 2024 in Massachusetts, Maryland, New York, and Puerto Rico in their preferred languages (English, Spanish, Mandarin, or Cantonese). Recruitment included outreach to settings that served racially and ethnically diverse older adults (for details, see Alegria et al., 2026¹⁶). See digital content for details on recruitment and engagement strategies.

Figure 1.

Consort Diagram of the Study Design

Abbreviations: PMSB-E, Positive Minds Strong Bodies-Enhanced.

Qualitative data came from semi-structured interviews with 19 participants randomized to the maintenance phase. The first and senior authors, with input from a mixed-methods consultant, developed two semi-structured interviews: one for those who accepted (reasons for the decision and perceived benefits) and one for those who declined (reasons for the decision). See digital content for sample interview questions.

Up to sixty-minute phone interviews were conducted (February 2023-August 2024) in participants’ preferred languages, audio-recorded, and transcribed. Cantonese and Mandarin interviews were translated and coded in English; Spanish interviews were coded in Spanish. Transcripts were analyzed in Dedoose.¹⁹ Participants were compensated with a $40 gift card.

Participants

Participants were adults ≥60 years with mild-to-severe depression (Patient Health Questionnaire, PHQ-9²⁰ ≥5 or Geriatric Depression Scale, GDS-15²¹ ≥5) or anxiety symptoms (Geriatric Anxiety Inventory,GAI²² ≥8) and minor-to-moderate mobility difficulties (Short Physical Performance Battery, SPPB²³ 3-11), excluding those with impaired capacity to consent,²⁴ recent or planned mental health treatment, cognitive impairment, substance use problems, psychosis, suicide risk,²⁵ or participation in the first PMSB trial.²⁶ To capture a range of perspectives during the interviews, we used maximum-variation sampling, deliberately interviewing participants who varied by language and intervention uptake.

PMSB-E Description

PMSB-E is a combined and concurrently delivered psychoeducational (Positive Minds) and exercise training (Strong Bodies) intervention with two phases: acute and maintenance.¹⁶ The maintenance phase is intended to sustain and enhance the benefits of the acute phase. The interventions are delivered by trained community health workers and exercise trainers, supervised by licensed clinicians.

Acute Phase (Months 1-6)

The psychoeducational intervention includes ten weekly 1-hour individual sessions to address negative cognitions (i.e., negative or unhelpful thoughts, or unhelpful ways of thinking), practice relaxation and mindfulness, promote behavioral activation, and encourage supportive relationships. The exercise intervention includes up to 36 1-hour sessions (three per week) focused on strength and balance using progressively weighted vests. See digital content for details on acute interventions.

Maintenance Phase (Months 7-12)

The maintenance interventions includes drop-in virtual group sessions, namely, psychoeducation (1 hour/week, total of 24) and exercise training (90 minutes/twice a week, total of 48), with participant capacity per session capped at 10 and 4, respectively. Because the maintenance intervention was offered as a drop-in option, participants were re-randomized to prevent selection bias (e.g., those perceiving greater benefit being more likely to accept). See digital content for acute versus maintenance phase differences.

Measures

Baseline characteristics included demographics, health status, and cognitive function (MoCA 5-minute protocol).²⁷ Depression and anxiety symptoms were measured using the Hopkins Symptom Checklist (HSCL-25),²⁸ which measures symptoms within the past 30 days on a 4-point scale. Total scores are the average of 25 items, with higher scores indicating worse symptoms. Physical function was measured using the SPPB,²³ a performance-based measure of lower extremity function; it includes three components scored from 0 (inability to complete) to 4 (best performance) which are summed to yield a total score, with higher scores indicating better function. The HSCL-25 and SPPB were collected at four time points (baseline, 3, 6, and 12 months) by study staff blinded to the participant assignment. We used HSCL-25 and SPPB scores to create an indicator variable for symptom recurrence at 12 months, setting it to 1 for participants who improved at 6 months but returned to baseline or worse by 12 months.

Quantitative Analytical Approach

We compared 12-month recurrence rates of depression/anxiety symptoms (HSCL-25) and mobility difficulties (SPPB) between participants who accepted versus declined the maintenance intervention in the overall sample and among interviewed participants. Missing data were handled using multiple imputation (BLiMP).²⁹ Then, we examined differences in the distribution of participants who accepted and declined the intervention by racial and ethnic groups. Finally, to identify participant-level characteristics associated with the intervention uptake, we compared the distribution of baseline characteristics between participants who accepted and declined the intervention, using χ² tests for categorical variables and t-tests for continuous variables, with a two-sided Type-I error rate of 0.05.

Qualitative Analytic Approach

All interview transcripts were analyzed using a thematic analysis framework that included data familiarization, code creation, codebook development, and theme generation.³⁰ We used a reflexive approach, in which the research team actively considered how their positionality might influence their interpretation of the data.

We developed a preliminary codebook to capture codes relevant to both groups (accepted and declined) using hybrid deductive-inductive coding.³¹ Deductive codes drew on literature on relapse-prevention participation³² and behavior maintenance theories.³³ Inductive codes emerged from participants’ data. We revised the codebook iteratively during the process. All transcripts were double-coded in Dedoose,¹⁹ with the two coders reaching consensus on discrepancies. The interviews were separated by group (accepted vs. declined) to iteratively generate themes – patterns of meaning.³⁰

Results

In total, 211 participants were randomized to the acute phase of the PMSB-E intervention (Months 1-6; Figure 1). During the maintenance phase (Months 7-12), 140 participants were re-randomized to either the maintenance intervention (n = 73) or the control group (n = 67). Of the 73 participants re-randomized to maintenance, 20 accepted, 28 declined, and 25 were lost to follow-up. The remaining 71 of 211 participants were not re-randomized because the maintenance phase was discontinued in the last nine months of the trial due to low uptake.

In the overall sample, 12-month recurrence was 18.8% for depression/anxiety symptoms (HSCL-25 scores) and 12.5% for mobility difficulties (SPPB scores). Among interviewed participants, recurrence was 21.1% for both outcomes (HSCL-25 & SPPB). No statistically significant differences in recurrence of depression/anxiety symptoms (HSCL-25) or mobility difficulties (SPPB) were observed between participants who accepted versus declined the intervention, either in the overall sample or among interviewed participants (Table 1).

Table 1.

Distribution of depression and anxiety symptoms and mobility difficulties recurrence at 12 months by maintenance intervention uptake (accepted and declined groups) in the overall sample and among interviewed participants

Recurrence at 12-months	Accepted	Declined	Total	P
Depression and anxiety symptoms
Overall
Yes	5 (25.0%)	4 (14.3%)	9 (18.8%)	.741
No	15 (75.0%)	24 (85.7%)	39 (81.3%)
Among interviewed participants
Yes	3 (25.0%)	1 (14.3%)	4 (21.1%)	.669
No	9 (75.0%)	6 (85.7%)	15 (78.9%)
Mobility Difficulties
Overall
Yes	3 (15.0%)	3 (10.7%)	6 (12.5%)	.589
No	17 (85.0%)	25 (89.3%)	42 (87.5%)
Among interviewed participants
Yes	2 (16.7%)	2 (28.6%)	4 (21.1%)	.912
No	10 (83.3%)	5 (71.4%)	15 (78.9%)

Note. Depression and anxiety symptom recurrence: HSCL-25 score lower than baseline at 6 months, but equal to or higher than baseline at 12 months. Mobility difficulties recurrence: SPPB score greater than baseline at 6 months, but equal to or lower than baseline at 12 months.

There was a trend indicating racial and ethnic differences in the probability of the intervention uptake. Asian participants trended toward higher acceptance rates (69.2%) than Latino (34.6%) and Black (28.6%) participants, though the differences were not statistically significant (p=0.089) (Table 2).

Table 2.

Probability of accepting maintenance intervention by racial and ethnic groups

Accepted the maintenance intervention	White	Black	Asian	Latino
	(n=2)	(n=7)	(n=13)	(n=26)	P
Yes	0 (0.0%)	2 (28.6%)	9 (69.2%)	9 (34.6%)	.089
No	2 (100.0%)	5 (71.4%)	4 (30.8%)	17 (65.4%)

As shown in Table 3, participants who accepted or declined the intervention were predominantly female, foreign-born, with ≥ high school education, and with ≥ 3 chronic conditions. Baseline characteristics were similar between groups, including in psychological factors, except participants ≥75 years were significantly more likely to accept the intervention than those aged 60-74 (50.0% vs. 14.3%, p=0.007). Additionally, a trend suggested that participants who accepted (vs. declined) the intervention had higher cognitive function scores (21.5 vs. 18.9, p = 0.090).

Table 3.

Distribution of baseline demographic and clinical characteristics by maintenance intervention uptake (declined and accepted groups)

Baseline characteristic	No. (%)
	Declined (n = 28)	Accepted (n = 20)	P
Age
60-74	24 (85.7%)	10 (50.0%)	.007
75+	4 (14.3%)	10 (50.0%)
Gender
Male	8 (28.6%)	7 (35.0%)	.636
Female	20 (71.4%)	13 (65.0%)
Education
Less than high school	11 (39.3%)	6 (30.0%)	.507
High school and above	17 (60.7%)	14 (70.0%)
Birthplace
Outside of the US	14 (50.0%)	13 (65.0%)	.302
United States	14 (50.0%)	7 (35.0%)
Marital Status
Married	12 (42.9%)	8 (40.0%)	.275
Divorced/separated	7 (25.0%)	4 (20.0%)
Widowed	4 (14.3%)	7 (35.0%)
Never Married	5 (17.9%)	1 (5.0%)
Primary Language
English	7 (25.0%)	5 (25.0%)	.367
Spanish	17 (60.7%)	8 (40.0%)
Mandarin	3 (10.7%)	5 (25.0%)
Cantonese	1 (3.6%)	2 (10.0%)
Chronic conditions, no (%)
0 chronic conditions	0 (0.0%)	0 (0.0%)	.674
1 chronic condition	2 (7.1%)	3 (15.0%)
2 chronic conditions	5 (17.9%)	3 (15.0%)
3+ chronic conditions	21 (75.0%)	14 (70.0%)
Smoking status
Current smoker	1 (3.6%)	0 (0.0%)	.311
Ex-smoker	10 (35.7%)	4 (20.0%)
Never smoke	17 (60.7%)	16 (80.0%)
Self-rated physical health
Excellent	1 (3.6%)	0 (0.0%)	.688
Very good	3 (10.7%)	2 (10.0%)
Good	8 (28.6%)	4 (20.0%)
Fair	13 (46.4%)	13 (65.0%)
Poor	3 (10.7%)	1 (5.0%)
Self-rated mental health
Excellent	1 (3.6%)	0 (0.0%)	.839
Very good	4 (14.3%)	3 (15.0%)
Good	10 (35.7%)	9 (45.0%)
Fair	10 (35.7%)	7 (35.0%)
Poor	3 (10.7%)	1 (5.0%)
Perceived Isolation
Hardly Never	15 (53.6%)	11 (55.0%)	.994
Some of the time	10 (35.7%)	7 (35.0%)
Often	3 (10.7%)	2 (10.0%)
Lack of companionship
Hardly Never	13 (46.4%)	8 (40.0%)	.754
Some of the time	7 (25.0%)	7 (35.0%)
Often	8 (28.6%)	5 (25.0%)
Cognitive Function, mean (SD)	18.9 (5.9)	21.5 (3.6)	.090
Depression and anxiety symptoms, HSCL-25, mean(SD)	1.6 (0.4)	1.6 (0.3)	.949
Physical functioning, SPPB, mean (SD)	8.0 (2.3)	8.3 (1.7)	.645

Note. SD: standard deviation;

^*p < .05.

Qualitative Findings

Nineteen interviews achieved data saturation. Most interviewed participants were female, Hispanic, Spanish-speaking, and aged 60-74. Interviewed and non-interviewed participants showed no significant demographic and clinical differences (Supplemental Table 1). Thematic analysis yielded three main themes, discussed below.

Theme 1. Participation in the maintenance intervention was associated with increased daily functioning, including improved mood and physical function.

Participants discussed how engaging in the maintenance intervention improved their mental and physical health. One participant highlighted the benefits, stating, “I improved physically, mentally, and in how well I get along with people” (P15). Participants perceived the intervention as effective in impacting their daily functioning. One participant remarked, “the change in my body…I feel like I have much more energy to exercise…with respect to the mental aspect…I face [difficult] situations with a little more calmness than before” (P8).

Participants reported developing skills to monitor their emotions and respond adaptively to challenging situations. One participant highlighted these skills by stating, “now when I am depressed…I will first solve the problem from my mentality. I cannot complain about the environment… because the problem is mainly based on [my] mentality” (P17). They also mentioned gaining skills to initiate and maintain physical activity: “I learned many little things that, even though I might have known them before, I wasn’t putting them into practice… I started by setting up an exercise routine” (P5).

Participants emphasized the importance of learning from others, with one participant noting, “because [when]…people shared their testimonies, I would say… ‘that person is dealing with their own things, they have good things going on like I do, or maybe they don’t have very good things going on…but… we can learn [from one another] and change in a radically positive way’” (P1). Further, participants also highlighted the positive impact of social support in establishing new habits and reinforcing existing ones, “I knew that I still [had] much to learn…so I was able to learn from other people and share our ideas together” (P18). There was consensus across participants regarding the challenges of loneliness and isolation faced by older adults. One participant stated, “and more so, adults like all of us, who sometimes, even when surrounded by many people, [we find ourselves] alone” (P5). This participant underscored the meaningful connections formed through interactions in the intervention, stating, “I felt accompanied because, even though we were having our chats and exercises virtually… I didn’t feel alone” (P5). Similarly, another participant discussed how the intervention, being group-based, fostered meaningful connections by keeping people engaged beyond the individually delivered acute intervention (Months 1-6), sharing, “I think that helped us improve a lot. To be with other people as well, and to meet other people.” (P13).

Participants benefited from structural support. One noted the importance of accountability: “I wasn’t going to do it on my own if I didn’t have someone to tell me, ‘look, let’s do this, let’s do that.’ Because sometimes you do not make up your mind to do things once you’re [not exercising/depressed]” (P6).

Theme 2. Older adults accepted the maintenance intervention to continue improving their health, and they trusted it would continue to offer benefits.

Older adults desired to maintain the gains from the acute phase (Months 1-6), with one participant noting “I wanted to maintain and strengthen the skills [I] learned” (P18). Further, there was also a sense that the intervention could deliver continued benefits, “I knew [the intervention] was helping me… this follow-up and those different stages that the plan presented kept [me] engaged…learning” (P5). Additionally, older adults recognized the importance of social connection for healthy aging and the challenges of sustaining it, viewing the intervention as an opportunity to address both — as one participant put it, “[I] didn’t feel alone” (P5). Finally, the perception that prioritizing health is essential to aging well seemed to influence decisions to participate; as one participant noted when accepting the intervention, “to better manage mobility while walking, the exercises that were going to strengthen certain parts of the body are the ones that most need to be strengthened in older age” (P7).

Theme 3. Older adults who declined to participate in the maintenance intervention appreciated the benefits of the acute phase (Months 1-6), recognized the benefits of focusing on their health, yet felt they had the tools and social environments to sustain the benefits gained during the acute phase.

Overall, participants expressed appreciation for what they learned during the acute phase. However, participants perceived themselves as adequately equipped to manage symptoms of depression and anxiety, stating, “The point is that [I] can catch [depression and anxiety]…and have …tools to help address whatever issues [I am ] dealing with” (p12). However, when deciding whether to participate in the maintenance intervention, participants considered the demands of their social environments — such as caregiving responsibilities or volunteer work. Many acknowledged that sustaining social connections can be challenging in later life, “the [PMSB-E] program had specific goals, but just participating in it was a good thing. Having something scheduled takes you out of your shell. It makes it hard to be isolated or lonely” (P11), however, they perceived themselves as socially connected, with the same participant adding “and, I am really speaking generally, because I am not lonely; with grandkids all the time, I’m always looking for a quiet moment” (P11). Other participants assessed their environments for needs and opportunities to remain meaningfully engaged. One participant noted: “[the acute phase] helped me, because I saw a lot of need. So, by acquiring that knowledge…it helped me deal with the community and talk to people” (P2).

Discussion

This study evaluated whether participation in a maintenance intervention was associated with nonrecurrence of psychological and mobility difficulties, older adults’ perceived benefits, and participant factors associated with uptake.

Benefits of Maintenance Interventions

Despite no quantitative differences in recurrence of psychological distress or mobility difficulties between groups, participants who accepted the intervention reported qualitative benefits beyond symptom relief, including improvements in daily functioning. These improvements were facilitated by two possible mechanisms: self-regulation and social processes. Maintenance theories suggest sustained behavior change requires ongoing self-regulation³³ (inhibiting automatic behaviors and emotions and replacing them with goal-oriented responses). Participants discussed monitoring their emotions, thoughts, and behaviors and using strategies to sustain change (e.g., setting exercise routines and cognitive reframing). Regarding social processes, participants reported benefits of the group-based format, which appeared to support self-regulation by providing an environment with contextual cues, accountability, structure, and social reinforcement conducive to sustaining gains from the acute intervention. Relatedly, loneliness emerged as a pervasive challenge to well-being, even among individuals embedded within families or communities. The intervention appeared to reduce feelings of loneliness by providing a relational, predictable context that cultivated companionship, mutual understanding, and a shared sense of purpose.

Uptake of Maintenance Interventions

Participation dropped from 80%-95% in the acute phase to 27% in the maintenance phase. This suggests sustaining long-term engagement is challenging, and that the factors sustaining ongoing participation may differ from those that prompted initial uptake.

Participants’ decision to accept or decline the intervention may reflect an evaluative process involving the prioritization of emotionally meaningful goals, appraisal of psychological capacity (e.g., self-regulation), and consideration of environmental demands and resources. Cognitive function may facilitate this process by supporting individuals’ ability to integrate these factors, anticipate barriers, and make decisions aligned with their needs and goals.

Across qualitative and quantitative data, old-old adults (75+) were more likely than middle-old adults (60-74) to accept the maintenance intervention. Socioemotional selectivity theory (SST)³⁴ and strength and vulnerability integration theory (SAVI)³⁵ may explain this finding. SST suggests perceptions of time, in addition to chronological age, shape goal prioritization, with age often serving as a proxy for shifts in perceived time horizons. This perspective may shed light on why both groups recognized the intervention as helpful. Still, once foundational skills were acquired, the decision to participate reflected the prioritization of emotionally meaningful goals. For some, participation reflected goals for further growth and connection; for others, the acquired skills during the acute intervention enabled a shift toward investing time in family or community.

Building on SST, SAVI suggests that, until approximately the late 60s, adults experience a pattern of increased positivity and well-being, followed by a slight decrease thereafter, attributed to decreased physiological tolerance to stress.³⁵ Thus, it may be that the old-old adults recognized their increased vulnerability to prolonged stressors (e.g., chronic illness) and recurrence of mental illness,¹¹ which may have influenced their decision to accept the intervention.

Further, appraisals of psychological capacity influenced uptake of the intervention. Participants who accepted the intervention perceived a strong need for structured support to continue practicing skills and strengthen self-efficacy, consistent with a gain-framed orientation toward aging, which prioritizes behaviors that sustain improvements and promote well-being.³⁶ In contrast, those who declined the intervention appraised their needs differently: they viewed acquired skills as sufficient to sustain gains independently. They described high self-efficacy in deploying self-regulation strategies to cope with future challenges. In other words, when older adults appraise their psychological capacity as adequate to sustain well-being, engagement in a maintenance intervention may be deprioritized, despite its perceived value, in pursuit of other emotionally meaningful goals.³³

Environmental demands and resources also influenced uptake – those who declined appraised their environmental context as providing adequate opportunities for meaningful goals (e.g., social connection). Relatedly, in our sample, Asian participants showed higher acceptance of the intervention than Latino participants, possibly reflecting environmental influences. Many Latino participants who declined were from Puerto Rico, suggesting greater social and linguistic integration than U.S. mainland-residing Asian participants. Thus, in contexts where social and linguistic integration is limited, access to language- and culturally-concordant care may influence older adults’ uptake of maintenance interventions.³⁷

Lastly, we observed a trend in which older adults with higher cognitive function were more likely to uptake the intervention, potentially because they could evaluate ongoing needs, recognize benefits, and troubleshoot barriers (e.g., technological barriers in a virtual intervention).³⁸ Interestingly, in a previous study, older adults with lower cognitive function, compared to those with no impairments, benefited from maintenance psychotherapy,¹² suggesting that cognitive function differentially influences maintenance treatment uptake versus benefit. Differences in intervention modality (virtual vs. in-person) may also contribute to this pattern, as engagement in technology-based interventions may add demands on cognitive and digital literacy skills, thereby limiting engagement.

Clinical implications

Guidelines for late-life mental health disorders recommend maintenance treatments in certain cases,³⁹ yet optimal strategies to sustain gains and promote uptake remain limited. Still, as Reynolds and colleagues observed, “getting well is not enough, it is staying well that counts.” ^40(p347) Our findings suggest that maintenance interventions are acceptable and emotionally meaningful to diverse older adults, but individual and contextual factors may influence uptake. In clinical practice, shared decision-making can help align potential benefits and fit with the patient’s goals, framing maintenance interventions as an opportunity to preserve long-term well-being.

Limitations

Results are exploratory given the small sample size, limiting the ability to draw conclusive statements about benefits, subgroup differences, and generalizability. Despite these limitations, findings provide preliminary insights into maintenance intervention benefits and uptake among diverse older adults, a needed contribution given the public health burden of recurrent late-life depression and anxiety.

Conclusion

This study is among the few to examine non-pharmacological maintenance treatments and is among the only ones to do so with racially, ethnically, and linguistically diverse older adults.⁸ Findings offer preliminary yet meaningful insights that older adults value flexible, culturally and linguistically concordant maintenance interventions and that may help sustain long-term mental health gains. Uptake, however, appears to hinge on alignment with personal, social, and environmental contexts. Factors sustaining participation in maintenance treatments may differ from those prompting initial uptake,³³ warranting further investigation.

DATA SHARING

The data collected for this study will not be made publicly available due to the sensitivity of the data involving racial and ethnic minorities and our agreements with the Institutional Review Board. In our consent forms, we promised that none of the information would be shared, except among research staff. We cannot provide the data unless they were highly de-identified, which would take substantial time.

DATA STATEMENT

The data have not been previously presented orally or as a poster at scientific meetings.