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. Author manuscript; available in PMC: 2022 Mar 1.
Published in final edited form as: Aging Ment Health. 2019 Dec 4;25(3):445–452. doi: 10.1080/13607863.2019.1698515

Acceptability of a Lay-Delivered Intervention for Depression in Senior Centers

Patrick J Raue 1, Alexis Dawson 1, Theresa Hoeft 1, Joan Russo 1, Dian Ferguson 2, Lynda Green 3, Claire Petersky 4, Cecily Kaplan 5
PMCID: PMC7269871  NIHMSID: NIHMS1550267  PMID: 31799880

Abstract

Objective:

We examined: 1. depression rates among senior center clients; and 2. the acceptability of a lay-delivered intervention for depression (“Do More, Feel Better”) from the perspective of key stakeholders prior to its implementation.

Method:

We conducted cross-sectional surveys at four Seattle-area senior centers of 140 clients, 124 volunteers, and 12 administrators and staff. Client measures included the Patient Health Questionnaire-9 (PHQ-9) to determine depression severity, and items assessing depression treatment preferences. Following description of “Do More, Feel Better” as a lay-delivered intervention focused on increasing participation in rewarding activities, we used quantitative and qualitative items to assess acceptability to: 1. clients participating in; 2. volunteers administering; and 3. administrators and staff supporting the intervention.

Results:

25% of senior center clients (35/140) endorsed elevated depressive symptoms (PHQ-9≥10). 81% of clients (114/140) reported that they would consider participating in “Do More, Feel Better,” and 59% percent of volunteers (73/123) expressed interest in learning how to assist others using the intervention. Administrators and staff reported high comfort levels with proposed volunteer training procedures, and they identified funding and staffing considerations as challenges to sustaining the intervention.

Conclusion:

Findings indicate high depression rates among senior center clients and support the acceptability of lay-delivered behavioral interventions for depression from a variety of stakeholders. Further investigation of the feasibility, effectiveness, and implementation of “Do More, Feel Better” is warranted, particularly in the context of a lack of health care professionals available to meet the mental health needs of older adults.

Keywords: depression, behavioral activation, lay-health workers, aging service settings

Introduction

Several reports have identified a substantial gap between the mental health needs of older adults and their receipt of adequate treatment (Bartels & Naslund, 2013; Eden, Maslow, Le & Blazer, 2012). Untreated depression is common among older adults, and is associated with poor health and mental health outcomes (Byers, Arean & Yaffe, 2012; Byers et al., 2008; Eggermont et al., 2012; Murray et al., 2012). Even mild forms of depression have been linked to diminished quality of life for older adults (Jia & Lubetkin, 2017).

Research has documented that community-dwelling individuals who attend senior centers have high rates of elevated depressive symptoms (Berman & Furst, 2014). Senior centers serve large numbers of mid to low-income adults and offer a variety of social, health, nutritional, and recreational programs and services (Caslyn & Winter, 1999; Pardasani, 2004; Turner, 2004). Senior centers, however, do not typically provide mental health services. Community-dwelling older adults with depression rarely follow through on referrals or pursue antidepressant treatment or psychotherapy (Gum, Hirsch, Dautovich, 2014; Ferrante & Schonfeld, 2014; Raue & Sirey, 2012; Sirey, 2013). Moreover, the existing workforce of geriatric mental health providers is insufficient to meet the needs of older adults (Bartels & Naslund 2013; Eden et al., 2012).

Aging care settings such as senior centers provide unique opportunities to test and offer innovative interventions that may be more acceptable to older adults than referrals to outpatient mental health care. SAMSHA and the National Council on Aging have highlighted the need to integrate mental health programs into aging service settings (NCOA, 2007; SAMHSA, 2012). Several investigators have also identified the potential value of nontraditional lay health providers in furthering these efforts (Bartels & Naslund 2013; Eden et al., 2012; Raue, Sirey, Dawson, Berman, & Bruce, in press). Indeed, a growing literature has documented the feasibility and effectiveness of a variety of lay-delivered behavioral interventions in community settings (Arjadi et al., 2018; Barnett, Gonzalez, Miranda, Chavira & Lau, 2018; Chartier & Provencher, 2013; Ekers, Richards, McMillan, Bland & Gilbody, 2011; Quijano et al., 2007).

In this light, we have developed a simplified version of Behavioral Activation for delivery by lay volunteer providers within senior centers and have labeled the 12-session intervention “Do More, Feel Better” (Raue et al, in press). We chose to adapt Behavioral Activation given its straightforward nature (Kanter, Busch & Rusch, 2009; Mazzucchelli, Kane & Reese, 2009) and strong evidence-base for treating depression in both mid-life (Coffman, Martell, Dimidjian, Gallop & Hollon, 2011; Cuijpers, Van Straten, Warmerdam, 2007; Dimidjian, Barrera, Martell, Munoz & Lewinsohn, 2011; Dimidjian et al., 2006; Ekers, Richards & Gillbody, 2008; Jacobson et al., 1996; Mazzucchelli et al., 2009) and older adults (Cernin & Lichtenberg, 2009; Chartier & Provencher, 2013; Gallagher & Thompson, 1982; Meeks, Looney, Van Haitsma & Teri, 2008; Snarki et al., 2011; Thompson, Gallagher & Breckenridge, 1987). Adaptations to our intervention include streamlined Behavioral Activation strategies and use of highly structured meeting agendas by lay providers. In-session worksheets support providers in their tasks regarding psychoeducation on depression, compilation of a tailored list of rewarding activities, and daily activity scheduling (see Figure 1 and Raue et al, in press for a more comprehensive description of the intervention. The “Do More, Feel Better” intervention manual is available from the first author). In addition, we designed “Do More, Feel Better” for potential implementation without research funding. As most senior centers support a variety of volunteer-led programs, “Do More, Feel Better” makes use of existing resources and thus has potential for being a sustainable service.

Figure 1.

Figure 1.

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“Do More, Feel Better” Intervention (12 weekly meetings)

Given the lack of available and acceptable mental health services for older adults, our long-term vision is document “Do More, Feel Better” as an acceptable, accessible, and effective psychosocial intervention for this underserved population. We previously tested the feasibility of “Do More, Feel Better” in a small randomized controlled trial in 2 senior centers in New York City, and found that we were able to train the majority of interested lay volunteers to rigorous fidelity standards (Raue et al, in press). We also found that depressed clients receiving the intervention reported high levels of meeting attendance and satisfaction, and decreases in depressive symptoms. This early pilot work allowed us to iteratively refine the intervention based on participant feedback and our observations on implementing the program.

Before formally testing “Do More, Feel Better” in a larger randomized controlled trial, the current study aimed to assess the extent to which such an intervention is needed and acceptable from the perspective of diverse stakeholders in 4 Seattle-area senior centers. We report: 1. the rate of elevated depressive symptoms (PHQ-9≥10) (Kroenke, Spitzer & Williams, 2001) among clients attending these senior centers; and 2. a variety of indicators of the acceptability of “Do More, Feel Better” to senior center clients, volunteers, administrators and staff prior to its implementation. We also examined the association of elevated depressive symptoms and client sociodemographic characteristics with their willingness to consider participating in “Do More, Feel Better”, and we assessed client preferences for other mental health treatments.

Methods

The study was approved by the University of Washington IRB. Participation was voluntary, and all client, volunteer, administrator, and staff participants provided written informed consent. No incentives or financial reimbursement were provided.

Study Participants:

Clients:

Study investigators completed surveys with 140 English-speaking clients aged 60 and older across 4 Seattle-area senior centers: Wallingford, Greenwood, Southeast, and Central Area. Of these clients, 74 also served as senior center volunteers and we administered both client and volunteer surveys to them.

Volunteers:

We completed surveys with 124 volunteers aged 60 and older across the four centers. Volunteers performed a variety of services including front desk/reception, kitchen duties, data management, and recreational and health promotion groups.

Staff:

We completed surveys with 12 administrators and staff across the four centers. Center roles included directors, volunteer coordinators, social workers, and program and event staff.

Procedures:

Study investigators conducted in-person cross-sectional surveys that included both closed and open-ended responses from October 2017 to September 2018. We used a variety of recruitment methods to reach as many clients who attended each center as possible, including on-site presence at center events, flyers, advertisements in center newsletters and online blogs, and wellness lectures held on-site and at neighboring senior housing facilities. Center staff identified volunteers and facilitated contact with study investigators. No clients, volunteers, administrators or staff had previous experience with the “Do More, Feel Better” intervention.

Measures:

Clients:

We collected sociodemographic information from clients and qualitative open-ended responses to questions about programs and services used at senior centers to understand what draws older adults to the centers. We asked clients whether they thought that emotional health and wellness were important to address in senior centers (yes/no). We then briefly described “Do More, Feel Better”: “We have developed a program for senior center clients who are depressed that we call ‘Do More, Feel Better.’ This program is provided by supervised volunteers and is based on research showing that increasing participation in pleasurable and rewarding activities can lead to improvement in depression symptoms. So the more you do, the better you feel.” Following this description, we asked clients: “If you were suffering from depression or had other emotional concerns, would you consider trying out such a program and meeting with a volunteer (who does not attend this center, but may be a client from another senior center)?” We used a 5-point Likert item (where 1=strongly disagree and 5=strongly agree) and created a dichotomous variable (score≥4) to reflect agreement. Using the same item stems, we asked clients about their desire for any formal mental health treatment “if you were suffering from depression or had other emotional concerns,” and then separately asked about psychotherapy and medication. We assessed primary depression treatment preference with the Cornell Treatment Preference Index (Raue et al., 2009) which asks clients to select one approach from the following options: antidepressant treatment, individual psychotherapy, group psychotherapy, lay-delivered programs, herbal remedies, religious or spiritual activities, exercise, or “do nothing.” Thus, our assessments tapped into client agreeableness to a variety of treatment approaches as well as their preference on how they would most like to be treated. Lastly, we administered the Patient Health Questionnaire (PHQ-9) to clients via interview format. The PHQ-9 is a 9-item measure that assesses severity of depressive symptoms, and has been shown to have good reliability and validity in identifying cases of major depression at a cutoff score of ≥10 (Kroenke, Spitzer & Williams, 2001). We chose the PHQ-9 because it is commonly used in primary care and community settings to screen for depressive disorders and indicates need for further mental health evaluation and care.

Volunteers:

We collected sociodemographic information and asked about current volunteer activities. Following a description of “Do More, Feel Better” and its procedures, we used 5-point Likert items (1=not at all; 5=very) dichotomized at ≥4 to assess comfort working with depressed individuals, and interest in learning how to assist others using “Do More, Feel Better.” For volunteers expressing interest in learning how to assist others (score≥4) we assessed willingness to travel to a neighboring senior center for this purpose, an element of the intervention we incorporated due to ethical concerns about maintaining professional boundaries. We also assessed volunteers’ willingness to commit to administering the 12-week program to 2–3 depressed clients over a 1-year period.

Administrators and Staff:

Quantitative measures included sociodemographic information on 2–4 administrators and staff per center. Following a description of “Do More, Feel Better” (Figure 1) and its training and supervision procedures, we used 5-point Likert items (1=not at all; 5=very) dichotomized at ≥4 to assess staff comfort with: volunteers delivering the program with appropriate supervision; use of a structured interview guide to select appropriate volunteers to be trained in the program; and proposed training and supervision procedures. Qualitative data in the iterative analysis came from open-ended questions following the above Likert items to elicit more details and inform intervention development. To gain understanding of facilitators and challenges in adopting “Do More, Feel Better” after conclusion of research-supported activities, we asked open-ended questions about: 1. possible methods to identify depressed clients who would benefit from the program; 2. interest and ability of centers to continue offering the program; and 3. anticipated availability of staff to undertake leadership of training and supervision responsibilities.

Analysis:

We present sociodemographic characteristics using mean and standard deviation for continuous variables, and frequency and percentage for categorical variables. We created dichotomous variables for all Likert items and present proportions of respondents endorsing positive responses (item score≥4).

We conducted bivariate analyses to identify associations between interest in “Do More, Feel Better” (item score≥4) and the following variables: elevated depressive symptoms (PHQ-9≥10), sociodemographic characteristics, and center site, using chi-square for categorical variables and t-test for continuous variables. Analyses were conducted using SPSS, version 25.0 (IBM, 2017). A two-tailed alpha level of .05 was used for each statistical test.

Qualitative open-ended responses from administrator/staff surveys (n=12) were initially summarized by the PI and co-investigators to inform intervention procedures during its development (Rubin & Rubin, 2005). This rapid qualitative assessment during intervention development is common in implementation research (NCI, 2019). The PI (PR) and one of the co-authors (TH) then used an iterative thematic analysis of open-ended responses from administrators and staff pertaining to intervention procedures and program sustainability in order to expand on quantitative findings (Borkan, 1999; Braun & Clarke, 2006; Rubin & Rubin, 2005). Responses were stored in an Excel document and coded using inductive thematic analysis to understand common themes arising in the data. Qualitative open-ended responses from client surveys were organized in a separate Excel document and analyzed thematically based on most common services described as well as certain services that were of interest to study investigators (e.g., case management, support groups). An additional “other” category captured items that did not fit into 12 main categories (described below). We summarized these findings based on the frequency with which they were endorsed as common reasons for attending senior centers.

Results

Clients:

We present sociodemographic variables for 140 client participants in Table 1. Clients reported participating in a broad range of senior center programs and services. In order of frequency, 58 clients (41%) attended congregate meals, 47 (34%) classes (e.g., computers, art, language, culture), 44 (31%) group exercise, 42 (30%) “other” or unspecified activities, 35 (25%) informal socialization opportunities, 30 (21%) games (e.g., bingo, cards, chess), 26 (19%) discussion groups, 23 (16%) health and wellness services (e.g., foot care, diabetes management, nutrition), 22 (16%) concerts or movies, 20 (14%) lectures, 12 (9%) non-class computer use, 9 (6%) support groups (e.g., Alzheimer’s support, Alcoholics Anonymous), and 2 (1%) case management (e.g., housing and legal assistance).

Table 1.

Sociodemographic Characteristics of Study Participants

Descriptor Clients N=140 Volunteer N=124 Staff N= 12
             
Mean SD Mean SD Mean SD
Age a 73.4 6.9 72.8 10.1 . .
Years of education 16.6 2.8 16.9 2.8 . .
N % N % N %
Senior Center
 Site 1 41 29.3 26 21.0 3 25.0
 Site 2 40 28.6 41 33.1 3 25.0
 Site 3 34 24.3 38 30.6 4 33.3
 Site 4 25 17.9 19 15.3 2 16.7
Gender
 Men 37 26.4 31 25 1 8.3
 Women 102 72.9 91 73.4 11 91.7
 Other 1 0.7 2 1.6 0 0
Race
 White 92b 66.2 86 69.4 7 58.3
 Black or African American 27 19.4 25 20.2 1 8.3
 Asian or Pacific Islander 7 5.0 7 5.6 3 25
 Native American 3 2.2 0 0 0 0
 Other race 2 1.4 1 0.8 0
 Multi-racial 8 5.8 5 4.0 1 8.3
Hispanic ethnicity
 Yes 3c 2.1 2 1.6 0 0
Married
 Yes 35 25.0 44 35.5 . .
Working
 Yes 17 12.1 16e 13.1 12 100
Medicaid
 Yes 18d 13.1 14f 12.2 . .
Elevated PHQ-9 score (≥10)
 Yes 35 25.0 . . . .
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a

age and education not asked for staff participants

b

sample size for Client Race=139

c

sample size for Client Hispanic ethnicity=138

d

sample size for Client Medicaid=137

e

sample size for Volunteer Working=122

f

sample size for Volunteer Medicaid=115

The mean PHQ-9 score was 6.0 (SD=5.4), with 25% of clients (35/140) endorsing elevated depressive symptoms (PHQ-9≥10). Rates of elevated symptoms did not vary by senior center site (chi square=2.60, df=3, p=0.46). Three clients (2.1%) endorsed item 9 on the PHQ, two of whom investigators determined to have passive suicidal ideation and one to have active suicidal ideation by clinical assessment.

Almost all clients (98.6%; 138/140) endorsed the importance of addressing emotional health and wellness in senior centers. Most (81.4%; 114/140) reported that they would consider participating in “Do More, Feel Better” (item score≥4) if they were “suffering from depression or had other emotional concerns.” Ninety-one percent of clients (32/35) who reported elevated depressive symptoms (PHQ-9≥10) were interested in the intervention in comparison to 78% (82/105) of those without elevated symptoms. This difference did not reach statistical significance (chi square=3.09, df=1, p=0.08). Neither senior center site (chi square=3.26, df=3, p=0.35) nor any sociodemographic variable was associated with client interest in the intervention (statistics not reported).

Furthermore, 88.4% of clients (122/138) reported that they would want to pursue some type of formal mental health treatment (item score≥4) if depressed, with 86.3% (120/139) wanting to receive psychotherapy and 41.8% (58/139) to receive antidepressant medication. Figure 2 presents clients’ first choice treatment options if they were to experience depression (available n=137). The most frequent option was individual psychotherapy (52; 38%), followed by exercise (33; 24%). Combining treatment options, 61% of patients (n=84) preferred an “active” evidence-based treatment as their first choice (e.g., individual psychotherapy, group psychotherapy, or antidepressant medication), 34% (n=47) preferred a complementary approach (e.g., exercise, religious or spiritual activities), 4% (n=5) preferred a lay-delivered approach, and 1% (n=1) to “do nothing” if they experienced depression.

Figure 2.

Figure 2.

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First Choice Treatment Options (N=137)

Volunteers:

Sociodemographic variables for 124 volunteer participants appear in Table 1. Volunteers reported a mean comfort level of 3.9 (SD=1.0) working with depressed individuals, with 63.6% (77/121) endorsing “high” comfort levels (item score≥4). Volunteers reported a mean interest level of 3.6 (SD=1.4) in learning how to assist depressed clients using “Do More, Feel Better”, with 59.3% (73/123) endorsing “high” interest levels. Rates of such interest level did not vary by senior center site (chi square=2.77, df=3, p=0.43). Among those with high interest, 86.4% (57/66) reported willingness to travel to a neighboring senior center other than the one they were attending, and 95.3% (61/64) reported willingness to commit to administering the program to 2–3 depressed clients over a 1-year period.

Administrators and staff:

Sociodemographic variables for 12 administrators and staff appear in Table 1. Overall comfort level was high on all domains assessed, including comfort with volunteers delivering the program (mean=4.4, SD=0.9), use of a structured interview guide to select appropriate volunteers (mean=4.2, SD=1.3), and proposed training and supervision procedures (mean=4.7, SD=0.7).

We used qualitative responses from administrators and staff to refine the intervention and our training procedures. The length and frequency of the sessions were generally acceptable, although one participant suggested 8 weeks (versus 12) given typical duration for programs at their center. The structured nature of the meeting agendas was deemed helpful and appropriate to guide volunteers. One participant highlighted the importance of time to establish a connection before jumping into an agenda. Responses supported the helpfulness of having volunteer providers travel to neighboring senior centers to deliver the program, which for some was directly tied to confidentiality or boundary considerations. Some staff identified limitations to this procedure, however, related to transportation issues, volunteer mobility restrictions, and possible client crossover across senior centers. One staff participant also pointed out that having volunteers travel to neighboring centers “could be an overly cautious approach.” Suggestions for training procedures emphasized training in confidentiality; procedures for suicide risk; working with clients from different cultures, and with those having low literacy or mild cognitive impairment; maintaining appropriate boundaries; and promoting use of formal mental health care. An example concerning the importance of boundaries was: “…if they feel the need to give practical assistance like driving the client to get groceries”. Comments about suicidality focused on the importance of having “procedures for suicide risk” and “back-up plans if clients are in distress and volunteers need help”.

Administrator and staff open-ended responses highlighted their preferred methods of identifing depression and cognitive impairment, and recruiting eligible clients to participate in “Do More, Feel Better”. In contrast to screening instruments like the PHQ-9 that are typical in health care settings, senior center staff reported that they relied on themselves and their relationships with clients to detect mental health and cognitive concerns: “We keep our eyes and ears open to our members.”; “The social worker here is helpful at this.” Respondents also identified newsletters and social media as mechanisms for recruiting eligible clients: “Client recruitment would be no problem. A staff person could do it informally, and we could promote the program in our newsletter.”

Qualitative findings underscored several sustainability considerations across all centers. Many staff endorsed the desirability of continuing to offer “Do More, Feel Better” provided research demonstrated it to be effective, but they articulated challenges related to funding and volunteer supervision: “If successful, I would like to continue the program, but that may only be possible if grant funding is available from other resources.”; “We would have to prioritize this; often volunteer programs are not supervised that frequently.”; “We would need to train an existing staff member like myself, or we could hire new staff. But if this staff member leaves the center, we would need to have a written training manual.” One respondent mentioned the possibility of recruiting a current volunteer, a retired social worker, to fill the training and supervision role.

Discussion

The study’s first principal finding was that among a diverse group of clients who were surveyed across 4 Seattle-area senior centers, 25% reported elevated depressive symptoms on the PHQ-9.

This rate is higher than the 10% noted among New York City senior center clients,8 possibly due to a different sampling methodology in the prior report that primarily targeted new client registrations. These high rates of elevated symptoms underscore the unmet need and public health significance of depression among senior center clients. The study’s second principal finding was that our lay-delivered behavioral intervention, “Do More, Feel Better”, was found to be highly acceptable to a diverse group of stakeholders including senior center clients, volunteers, and administrators and staff.

A large majority of senior center clients (81.4%) reported that they would consider participating in the “Do More, Feel Better” intervention if they were depressed. While this proportion did not vary significantly by current depression status, it is notable that 91% of clients who scored 10 or higher on the PHQ-9 reported favorable attitudes toward the intervention. We found no significant variation in such interest level by senior center site or any sociodemographic variable, which further increases the generalizability of our results. In inquiring about the acceptability of other treatments, 88.4% of clients were also agreeable to pursuing some type of formal mental health treatment, in particular psychotherapy. Interestingly, when we asked clients to select their primary depression treatment preference, very few (4%) chose a lay-delivered intervention like “Do More, Feel Better”. Most clients (61%) chose an “active” evidence-based treatment such as psychotherapy or antidepressant medication as their first choice. How do we understand these seemingly discordant findings about client interest in “Do More, Feel Better” in comparison to other treatment options? The pattern of findings we observed may be consistent with our framing of “Do More, Feel Better” as a wellness program that can supplement formal mental health services. From a real world perspective, however, there is a dearth of professionals available to provide mental health services to older adults (Bartels & Naslund, 2013; Eden et al., 2012), and the majority of depressed older adults who receive a referral do not follow through (Gum et al., 2014; Ferrante & Schonfeld, 2014; Raue & Sirey, 2012, Sirey 2013). Given these realities, we are encouraged that senior center clients would consider participating in a lay-delivered intervention even if it may not be their primary treatment preference. Further examination, however, of the underlying reasons for clients’ primary preferences for professional services would be helpful and could inform co-design of lay-delivered approaches for future trials.

From the perspective of senior center volunteers, many (59.3%) reported interest in learning how to assist depressed individuals using the “Do More, Feel Better” intervention. Of those who expressed such interest, most were willing to travel to a neighboring center to do so (86.4%) and to commit to delivering the intervention to 2–3 clients (95.3%). We find this degree of interest quite encouraging in light of their current volunteer responsibilities and the novelty of supporting others with mental health needs in such a structured way. We note that such expressed interest does not necessarily equate to the capacity to deliver the intervention with fidelity. To this end, we have developed an Interview Guide (available from the authors) to determine volunteer eligibility for training, and a rigorous month-long certification process before volunteers are certified as coaches and approved to work with depressed clients. We also note possible benefits to volunteers themselves through their delivery of the intervention. Indeed, one study found that community health workers who learned how to address stress and coping among their clients reported improvements in their own depressive symptoms, stress, and coping (Tran et al., 2014).

From the perspective of senior center administrators and staff, we elicited concerns about confidentiality, boundaries, and other issues, and we incorporated their suggestions into our training and supervision procedures. Administrators and staff also raised many issues pertaining to the potential sustainability of “Do More, Feel Better”. For example, they identified the need for funding and appropriate personnel to continue the program without research support. Despite all centers in the current study employing a social worker and in most cases a volunteer coordinator, there were consistent concerns about identifying staff who were capable and would have the time to take over leadership of the program. Responses highlighted specific methods of identifying and managing mental health issues in senior centers, which differ from methods common in health care settings. For example, most senior centers do not use standardized screening tools for depression nor do they have the capacity to provide formal mental health treatment. New York City is an exception and has led the way in adopting innovative mental health initiatives. For example, “Thrive NYC” is a comprehensive mental health plan whose mission involves integrating mental health screening and treatment into aging care settings (Thrive NYC, 2019). Our preliminary qualitative findings in this pilot study of 12 administrators and staff may lay the foundation for follow-up assessments after program implementation and for more rigorous inquiry across larger samples of senior centers.

No other studies to our knowledge have formally evaluated the feasibility and acceptability of psychotherapy or other psychosocial interventions for depression in senior centers. While the “Thrive NYC” initiative involves integration of psychotherapy into a variety of community-based organizations including but not limited to senior centers (Thrive NYC, 2019), Thrive was not designed for rigorous research evaluation. Similarly, “SMART-MH” is a New York City program that implemented a model of care for a culturally and linguistically diverse group of older adults consisting of community outreach, assessment, and direct provision of brief psychotherapy (Sirey et al., 2017). Another program in development is a peer companionship intervention called “The Senior Connection” that aims to prevent the development of suicidal ideation among at-risk older adults (Van Orden, Stone, Rowe, et al, 2013). Primary care patients who report a low sense of belongingness or feeling like a burden on others are linked to community-based aging service settings in which the peer-led intervention is provided. While “Do More, Feel Better” is the first depression-specific intervention to be evaluated for its feasibility and acceptability within senior centers, the above programs may offer valuable lessons for larger-scale implementation. For example, outreach efforts and standardized assessment of eligibility are important strategies to increase the uptake of such psychosocial interventions. Moreover, linkages between senior centers and local primary care or community mental health clinics may extend program reach. One implementation model for “Do More, Feel Better” could draw from integrated mental health efforts within primary care settings (Archer, Bower, Gilbody, Lovell, Richards, Gask, Dickens, & Coventry, 2012) and partnerships between a variety of community-based organizations and health care settings that strive to meet individuals’ mental health needs (Hoeft, Fortney, Patel, & Unützer, 2018; Van Orden et al, 2013.

Study limitations include recruitment of a convenience sample of senior center clients and a focus on four Seattle-area centers that may not be representative of other centers across the country. We acknowledge that reports of intervention acceptability do not reflect actual participation in the intervention. Our ongoing research efforts will more directly test feasibility and acceptability of Do More, Feel Better” by examining intervention participation rates for both depressed clients and center volunteers. We also note the possibility of bias in our interviews with center administrators and staff, and that these participants may have reported overly positive responses to study investigators. However, we made efforts to elicit constructive critiques, and our interview format allowed us to present and discuss intervention materials and training procedures to ensure participants’ understanding of survey items.

In summary, study findings indicated a high rate of depression among individuals who attend Seattle-area senior centers. We found strong support from a variety of stakeholders for the acceptability of lay-delivered behavioral interventions for depression such as “Do More, Feel Better”. In context of a lack of available and acceptable mental health services for older adults with depression, our intervention may have particular promise given use of existing volunteer resources. Study findings therefore call for further investigation of the feasibility and effectiveness of “Do More, Feel Better”. Findings also highlight the value of testing different models of intervention implementation, for example via existing on-site senior center staff or alternatively via off-site linkages to supervision provided at nearby primary care or community mental health clinics.

Acknowledgments

Grant support: National Institute of Mental Health R34 MH111849

Footnotes

Data Availability

The data generated during and/or analyzed in this study are available from praue@uw.edu on reasonable request or may be accessed via Synapse, and open access data repository, https://www.synapse.org/#!Synapse:syn18919146/files/ (Raue, 2019).

Disclosures: The authors report no conflict of interest.

Clinical Trials Number: NCT03371771

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