Feasibility of a family-centered intervention for depressed older men in primary care.

OBJECTIVE: Families provide considerable support to many older adults with depression, yet few intervention studies have sought to include them. Family participation in depression treatment aligns with the preferences of older men, a group at high risk for depression under treatment. This study examined the feasibility of a family-centered depression intervention for older men in a primary care setting. METHODS: A clinical trial was conducted in a Federally Qualified Health Center (FQHC) in California's Central Valley. Depressed older men (age 50 and older) were allocated to usual care enhanced by depression psychoeducation or a family-centered depression intervention delivered by a licensed clinical social worker. Intervention feasibility was assessed in terms of recruitment, retention, and extent of family engagement. The PHQ-9 was administered at baseline, 1, 3, and 6 months. RESULTS: For more than 6 months, 45 men were referred to the study; 31 met the inclusion criteria, 23 were successfully enrolled, and 20 (88%) participated in more than or equal to one treatment sessions. Overall, 85% (11 of 13) of men allocated to the intervention engaged a family member in more than or equal to one session and 54% (7 of 13) engaged the family member in more than or equal to three sessions. While men in both groups showed evidence of a significant decline in PHQ-9 scores early on, which attenuated over time, there were no significant between group differences. CONCLUSIONS: Our family-centered depression intervention showed acceptable feasibility on the basis of a variety of parameters. Future research on family-based approaches may benefit from longer duration and more intensive treatment as well as additional strategies to overcome recruitment barriers.

Cultivating a Resiliency Model for Emergency Department and Intensive Care Unit Staff Through Peer Support: A Program Description.

Emergency department (ED) and intensive care unit (ICU) staff experience significant and ongoing exposure to mental health trauma due to the extremely high number of tragic cases consistently seen. Despite awareness of the magnitude of this problem, there is a scarcity of clinical efforts directed toward reducing and managing secondary traumatic stress and vicarious trauma. In an effort to promote resiliency in these frontline workers, we describe development and implementation of the Adapted Peer Support Resiliency Program (APSRP), a psychoeducational and cognitive reframing behavioral-based program equipped with peer support professionals who are trained in cognitive-behavioral strategies specifically tailored toward the needs of this population. The APSRP is an adaption of concepts and coping skills utilized by the Penn Resilience Program, which has previously demonstrated efficacy in combating a range of psychological problems (e.g., anxiety, depression, substance abuse, eating disorders, and severe mental illness). The APSRP incorporates a range of cognitive-behavioral strategies inclusive of cognitive reframing skills, role-playing, and behavior rehearsal. This proposed program was facilitated and supervised by a licensed mental health professional and implemented by fellow ED and ICU peer professionals. Components of the APSRP model are discussed. Suggestions for directing future efforts within this needed area are offered.

Aging and toxins.

This article addresses physiologic organ system and cellular mechanisms of common toxic exposure in the elderly population. Air pollution, tobacco, alcohol, heat, cold, water pollution, medications, herbals,radiation, and other chemicals are discussed.