Table 2.

Studies that Report Depression Treatment Outcomes for Minority Older Adults

Study/Year	Population/Setting	Depression-Related Objective	Protocol/Intervention	Depression Outcomes	Design	Similar Groups at Baseline	Equally Treated Groups	Follow-up/Drop-out	Data Analysis	Results
Areán et al. /2005	1748 participants age 60+ in primary care settings; Mean age = 71.2 years; 1131 women; 222 African American; 138 Latino; 1388 NHW	To test if a collaborative care model is as effective in improving depression in older minorities as with NHW.	Exp: Collaborative stepped care approach included antidepressant medication, PST-PC, educational materials, and support/monitoring provided by depression clinical specialists. Control: usual care.	HSCL-20 score; complete remission (HSCL-20 score < 0.5), response (≥50% HSCL-20 reduction)	Multi-site RCT; Blind-rated.	yes	yes	Follow-up: 3, 6, and 12 months post baseline. Drop-out: 10%, 13%, and 17% at 3, 6, and 12 months.	Intent-to-treat; Multiple imputation technique.	Collaborative care was as effective in improving depression outcomes in older minorities as NHW at 12 months.
Areán et al. /2008	1524 participants age 65+ in primary care settings; Mean age = 73.9 years; 467 women**; 404 African American; 280 Latino; 105 Asian; 48 other; 687 NHW.	To compare MH/SA service integration to brokerage care management depression* treatment outcomes for older minorities and NHW.	Exp: MH/SA (i.e., antidepressant medication, psychotherapy, case management, and brief behavioral alcohol intervention) were integrated in primary care. Specific algorithms not followed. Brokerage case management: Primary care provider conducted initial evaluation and referred to MH/SA services and social services in a separate location.	CES-D score	Multi-site RCT; Not blind-rated**	yes**	yes	Follow-up: 3 and 6 months post baseline. Drop-out: 20% at 6 months.	Intent-to-treat; Mixed effects regression models across time points.	No significant depression treatment outcomes were found at 6 months although access to depression care was enhanced for all groups.
Bogner & de Vries /2010	58 participants, ages 50–80 in primary care setting; Mean age = 60.2 years; 49 women; All African American.	To examine whether integrating depression treatment into care for Type 2 diabetes improves depression and diabetes outcomes.	Exp: Integrated care manager liaised between physician and patient, and conducted individualized in-person sessions and phone monitoring contacts to provide education and support in medication adherence, monitor side effects, and assess progress. Control: Usual care.	CES-D score	RCT; Not blind-rated.	yes	yes	Follow-up: 12 weeks post baseline. Drop-out: 0%	All available data. No missing cases.	Integrated depression & diabetes care was more effective than usual care in improving depression outcomes. Experimental group reported fewer depressive symptoms at 12-weeks.
Ell et al. /2010	1081 participants ages 18–97 in pooled analysis of 2 primary care settings, and 1 home care setting; Subsample of 440 older adults ages 60–97, mean age = 71.6 years includes 331 women; 214 Latinos; 26 African Americans; 7 Asians; 187 NHW; and 6 other.	To compare effectiveness of collaborative care for depression between older and younger adults with comorbid illness.	Exp: Collaborative stepped care approach included antidepressant medication, PST-PC, educational materials, and support/monitoring provided by depression clinical specialists who provided monthly telephone monitoring, relapse prevention, and navigation of community and care systems. Optional open-ended PST support group was offered in the cancer and diabetes trials, but not the home care trial. Control: Participants in enhanced usual care received educational pamphlets on depression. Patients from cancer and diabetes trials were provided with community resource lists.	50% PHQ-9 reduction from baseline.	Pooled data of 3 RCTs; Blind-rated.	Not explicit between Exp and Control groups	yes	Follow-up: 6 or 8 months, & 12 months post baseline. Drop-out: Among older adults, 35.5% & 42.3% dropped out at 6- and 12-months respectively	Intent-to-treat; Sensitivity analysis to compare results using all-available raw data & imputed data.	Compared to patients in usual care, patients in collaborative care had significantly greater improvements at 6-months regardless of age. There were no significant differences in reducing depression symptoms between older and younger patients.
Husaini et al. /2004	303 participants in subsidized high-rise apartments, ages 55–90 years; Mean age = 73.7 years. All women. 121 African American; 182 NHW	To examine the effectiveness of group therapy in reducing depressive symptoms, and to explore the effects of the program by age, race, and level of depression prior to treatment.	Exp: 6-week, 12-session group therapy program. Modules include cognitive and re-motivation therapy, exercise and preventive health behaviors, management of chronic medical conditions, reminiscence and grief therapy, and social skills development. Control: no program.	GDS-15 score	Quasi-experimental. Not known if blind-rated.	African American, but not NHW participants were similar	Yes	Follow-up: 3 and 6 months post-program. Drop-out: 4% at 3 months and unreported at 6 months.	Analysis of missing data not explicitly reported.	There were no main or interaction effects for African Americans with or without depression prior to treatment, or by age group. NHWs in treatment did better than those in the control group. NHWs ages 55–75 did better than those 76+.
Lichtenberg /1997	41 participants, age 60+ in inpatient rehabilitation hospital; 37 in analysis; Mean age = 78 years; 31 women; 32 African American; 5 NHW***	To evaluate if an inpatient depression treatment program reduces depression.	Subjects were assigned to groups in cohorts. Cohort 1: behavioral treatment sessions (30 minute sessions 2x/week) delivered by geropsychologist. Cohort 2: behavioral treatment sessions (daily, coincident with occupational therapy sessions) delivered by occupational therapists. Depression treatment sessions include relaxation & imagery, pleasurable events, mood ratings, and positive social praise. Cohort 3: no intervention comparison group.	GDS-30 score	Quasi-experimental. Not known if blind-rated.	yes	Cohorts 1 and 2 vary by more than one variable	Follow-up: Post-study assessment conducted within 24 hours prior to discharge from rehab hospital. Drop-out: 9.8% (4 subjects)	Drop-outs were not included in analysis.	Behavioral treatments for depression are effective in improving depression outcomes in older inpatients provided by either interventionist.
Quijano et al. /2007	94 participants, age 60+ in 3 community based service agencies; Mean age = 72.5 years; 74 women; 19 African American; 41 Latino; 2 Other; 32 NHW; 74 female	To evaluate an evidence-based depression intervention for frail older adults.	Subjects provided four treatment components provided by case managers: (1) screening and assessment; (2) education; (3) referral and linkage; and (4) behavioral activation (helping client identify an activity that fit with his/her values and monitoring the client’s progress in implementing their activity goals).	GDS-15 score	Pre-experimental. Not blind-rated.	N/A	N/A	Follow-up: 3 and 6 months post baseline. Drop-out: 22.3% and 28.7% at 3-and 6-months respectively	Drop-outs were not included in analysis.	There was a significant reduction in depression severity from baseline to 6-months.

Note: NHW = non-Hispanic white; Exp = experimental; HSCL = Hopkins Symptom Checklist; MH/SA = mental health and service abuse; CES-D = Center for Epidemiologic Studies Depression Scale; GDS = Geriatric Depression Scale; PHQ = Patient Health Questionnaire

^*Includes only the subsample of participants with depressive disorder

^**Reported in related study (52)

^***Reported in related article (53)