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PROTECT: a novel psychotherapy for late-life depression in elder abuse victims

Published online by Cambridge University Press:  30 April 2021

Jo Anne Sirey
Affiliation:
Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
Nili Solomonov
Affiliation:
Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
Arielle Guillod
Affiliation:
Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
Paula Zanotti
Affiliation:
Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
Jihui Lee
Affiliation:
Department of Population Health Sciences, Weill Cornell Medicine, White Plains, New York, NY 10605, USA
Mohamed Soliman
Affiliation:
Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
George S. Alexopoulos
Affiliation:
Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
Corresponding
E-mail address:

Abstract

Elder abuse is prevalent, and victims have high rates of depression and low quality of life. We established an academic–community partnership to test the feasibility, acceptability, and impact of a brief psychotherapy for depression (PROTECT) among elder abuse victims with capacity to make decisions. Elder abuse service providers referred depressed (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) older victims (age ≥ 55 years) for potential pilot study participation. Forty eligible victims who consented were randomized to PROTECT psychotherapy (N = 25) or a Usual Care (N = 15) condition involving a community psychotherapy referral. Follow-up research assessments were conducted at 6 weeks (mid-treatment) and 9 weeks (end of treatment) after study initial assessment. We used mixed-effects regression models to examine treatment effects on depression severity and quality of life over time. Most victims (75%) reported two or more types of abuse. The a priori acceptability benchmark was met at the end of PROTECT therapy. All PROTECT participants initiated therapy; this engagement rate is greater than the a priori 75% standard set for feasibility. We found a significant reduction in depression severity (Montgomery–Åsberg Depression Rating Scale [MADRS]), with PROTECT leading to greater benefits compared to Usual Care. Both study groups had a similar improvement in quality of life. The pilot project results found that PROTECT psychotherapy is feasible, acceptable, and effective in reducing depression. With the support of our partnership, we found that PROTECT could be delivered alongside elder abuse services with victims willing to initiate therapy that leads to meaningful treatment effects.

Type
Brief Report
Copyright
© International Psychogeriatric Association 2021

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References

Alexopoulos, G. S. (2019). Mechanisms and treatment of late-life depression. Translational Psychiatry, 9(1), 188.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Raue, P. J., Banerjee, S. et al. (2020). Comparing the streamlined psychotherapy “Engage” with problem-solving therapy in late-life major depression. A randomized clinical trial. Molecular Psychiatry.Google Scholar
Dong, X., Simon, M., Mendes de Leon, C. et al. (2009). Elder self-neglect and abuse and mortality risk in a community-dwelling population. Journal of the American Medical Association, 302(5), 517526.CrossRefGoogle Scholar
Sirey, J. A., Berman, J., Salamone, A. et al. (2015a). Feasibility of integrating mental health screening and services into routine elder abuse practice to improve client outcomes. Journal of Elder Abuse & Neglect, 27(3): 254269.CrossRefGoogle ScholarPubMed
Sirey, J. A., Halkett, A., Chambers, S. et al. (2015b). PROTECT: a pilot program to integrate mental health treatment into elder abuse services for older women. Journal of Elder Abuse & Neglect, 27(4–5), 438453.CrossRefGoogle Scholar
Sirey, J. A., Meyers, B. S., Teresi, J. A. et al. (2005). The Cornell Service Index as a measure of health service use. Psychiatric Services, 56(12), 15641569.CrossRefGoogle ScholarPubMed
Sirey, J. A., Raue, P. J., Solomonov, N. et al. (2020). Community delivery of brief therapy for depressed older adults impacted by Hurricane Sandy. Translational Behavioral Medicine, 10(3), 539545.CrossRefGoogle ScholarPubMed
Solomonov, N., Bress, J. N., Sirey, J. A. et al. (2019). Engagement in socially and interpersonally rewarding activities as a predictor of outcome in “engage” behavioral activation therapy for late-life depression. American Journal of Geriatric Psychiatry, 27(6), 571578.CrossRefGoogle ScholarPubMed

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