Layperson-Supported, Web-Delivered Cognitive Behavioral Therapy for Depression in Older Adults: Randomized Controlled Trial.

BACKGROUND: Depression is the most prevalent mental health condition in older adults. However, not all evidence-based treatments are easily accessible. Web-delivered cognitive behavioral therapy (wCBT) facilitated by laypersons is a viable treatment alternative. OBJECTIVE: This randomized controlled trial aims to evaluate the efficacy of a novel wCBT program, Empower@Home, supported by trained lay coaches, against a waitlist attention control. Empower@Home is among the very few existing wCBT programs specifically designed for older adults. The primary objective was to assess the efficacy of the intervention compared with attention control. The secondary objective was to evaluate the program's impact on secondary psychosocial outcomes and explore potential change mechanisms. METHODS: Older adults (N=70) were recruited via web-based research registries, social media advertisements, and community agency referrals and randomly assigned to either the intervention or control group in a 1:1 allocation ratio. The intervention group received access to Empower@Home, which included 9 web-delivered self-help lessons and weekly telephone coaching sessions by a trained layperson over 10 weeks. The control group received weekly friendly phone calls and depressive symptom monitoring. The primary clinical outcome was the severity of depressive symptoms assessed using the Patient Health Questionnaire-9. The secondary clinical outcomes included anxiety, anger, social isolation, insomnia, pain intensity, and quality of life. Linear mixed modeling was used to determine the treatment effects on depression, and 2-tailed t tests were used to assess within-group changes and between-group differences. RESULTS: Most participants in the intervention group completed all 9 sessions (31/35, 89%). The usability and acceptability ratings were excellent. The intervention group had a large within-group change in depressive symptoms (Cohen d=1.22; P<.001), whereas the attention control group experienced a medium change (Cohen d=0.57; P<.001). The between-group effect size was significant, favoring the intervention group over the control group (Cohen d=0.72; P<.001). In the linear mixed model, the group-by-time interaction was statistically significant (b=-0.68, 95% CI -1.00 to -0.35; P<.001). The treatment effects were mediated by improvements in cognitive behavioral therapy skills acquisition; behavioral activation; and satisfaction with the basic psychological needs of autonomy, competence, and relatedness. Furthermore, the intervention group showed significant within-group improvements in secondary psychosocial outcomes, including anxiety (P=.001), anger (P<.001), social isolation (P=.02), insomnia (P=.007), and pain (P=.03). By contrast, the control group did not experience significant changes in these outcome domains. However, the between-group differences in secondary outcomes were not statistically significant, owing to the small sample size. CONCLUSIONS: Empower@Home, a wCBT program supported by lay coaches, was more efficacious in reducing depressive symptoms than friendly telephone calls and depression symptom monitoring. Future studies should examine the effectiveness of the intervention in community and practice settings using nonclinician staff already present in these real-world settings as coaches. TRIAL REGISTRATION: ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/44210.

Activity Limitations and Depression Among Middle-Aged and Older Adults in China: The Moderating Impact of Assistance Adequacy.

This study aimed to examine the risk and protective factors associated with depression in middle-aged and older Chinese adults with activity limitations. Data were obtained from the 2018 Wave 4 Survey of the China Health and Retirement Longitudinal Study. In the logistic regression analysis, health and functioning, losing a child, and a perceived lack of future assistance with daily activities increased the odds of depression. Conversely, receiving adequate assistance with daily activities lessened the depressive impacts of activity limitations, as indicated by a significant interaction effect. Enhanced long-term support for individuals with disabilities is necessary to improve mental health.

Evaluation of the Current State of Chatbots for Digital Health: Scoping Review.

BACKGROUND: Chatbots have become ubiquitous in our daily lives, enabling natural language conversations with users through various modes of communication. Chatbots have the potential to play a significant role in promoting health and well-being. As the number of studies and available products related to chatbots continues to rise, there is a critical need to assess product features to enhance the design of chatbots that effectively promote health and behavioral change. OBJECTIVE: This scoping review aims to provide a comprehensive assessment of the current state of health-related chatbots, including the chatbots' characteristics and features, user backgrounds, communication models, relational building capacity, personalization, interaction, responses to suicidal thoughts, and users' in-app experiences during chatbot use. Through this analysis, we seek to identify gaps in the current research, guide future directions, and enhance the design of health-focused chatbots. METHODS: Following the scoping review methodology by Arksey and O'Malley and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, this study used a two-pronged approach to identify relevant chatbots: (1) searching the iOS and Android App Stores and (2) reviewing scientific literature through a search strategy designed by a librarian. Overall, 36 chatbots were selected based on predefined criteria from both sources. These chatbots were systematically evaluated using a comprehensive framework developed for this study, including chatbot characteristics, user backgrounds, building relational capacity, personalization, interaction models, responses to critical situations, and user experiences. Ten coauthors were responsible for downloading and testing the chatbots, coding their features, and evaluating their performance in simulated conversations. The testing of all chatbot apps was limited to their free-to-use features. RESULTS: This review provides an overview of the diversity of health-related chatbots, encompassing categories such as mental health support, physical activity promotion, and behavior change interventions. Chatbots use text, animations, speech, images, and emojis for communication. The findings highlight variations in conversational capabilities, including empathy, humor, and personalization. Notably, concerns regarding safety, particularly in addressing suicidal thoughts, were evident. Approximately 44% (16/36) of the chatbots effectively addressed suicidal thoughts. User experiences and behavioral outcomes demonstrated the potential of chatbots in health interventions, but evidence remains limited. CONCLUSIONS: This scoping review underscores the significance of chatbots in health-related applications and offers insights into their features, functionalities, and user experiences. This study contributes to advancing the understanding of chatbots' role in digital health interventions, thus paving the way for more effective and user-centric health promotion strategies. This study informs future research directions, emphasizing the need for rigorous randomized control trials, standardized evaluation metrics, and user-centered design to unlock the full potential of chatbots in enhancing health and well-being. Future research should focus on addressing limitations, exploring real-world user experiences, and implementing robust data security and privacy measures.

Optimization of Physical Refining Process of Camellia Oil for Reduction of 3-Monochloropropane-1,2-Diol (3-MCPD) Ester Formation Using Response Surface Methodology on a Laboratory Scale.

Refined and deodorized camellia oil has been reported to contain a high amount of 3-monochloropropane-1,2-diol esters (3-MCPDE) due to the high-temperature deodorization step. To reduce 3-MCPDE in camellia oil, the physical refining process of camellia oil was simulated on a laboratory scale. Response surface methodology (RSM) was designed to modify and optimize the refining process with five processing parameters (water degumming dosage, degumming temperature, activated clay dosage, deodorization temperature and deodorization time). The optimized new refining approach achieved a 76.9% reduction in 3-MCPDE contents, in which the degumming moisture was 2.97%, the degumming temperature was 50.5 °C, the activated clay dosage was 2.69%, the deodorizing temperature was 230 °C, and the deodorizing time was 90 min. A significance test and analysis of variance results demonstrated that the deodorization temperature and deodorization time contributed significantly to the reduction of 3-MCPD ester. The joint interaction effects of activated clay dosage and deodorization temperature were significant for 3-MCPD ester formation.

Entertain Me Well: An Entertaining, Tailorable, Online Platform Delivering CBT for Depression.

Depression prevalence is high, impacting approximately 20% of Americans during their lifetime, and on the rise due to stress and loss associated with the COVID-19 pandemic. Despite the high prevalence of depression, unacceptable treatment access disparities persist. When depression goes untreated, it leads to substantial negative impacts in multiple life domains. Cognitive behavioral therapy (CBT), the gold-standard psychosocial treatment for depression, remains largely unavailable to individuals living with depression, particularly individuals who are members of underrepresented groups in our society. Digital mental health interventions (DMHI) have led to important advances in extending the reach of CBT for depression; however, they are underutilized and treatment engagement remains low. We sought to address some of the current gaps in DMHI by developing an online platform for delivering CBT for depression that is entertaining, simple and straightforward, and tailorable. First, this article introduces our online platform, Entertain Me Well (EMW) and its key innovations, including the use of an engaging, character-driven storyline presented as "episodes" within each session, as well as customizable content that allows for tailoring of text, images, and examples to create content most relevant to the target client population, context, or setting. Next, we describe two EMW depression treatment programs that have been tailored: one for delivery in the rural church setting, called Raising Our Spirits Together, and one tailored for delivery in dialysis centers, called Doing Better on Dialysis. Finally, we discuss future directions for the EMW platform, including the ability to create programs for other common mental health and health conditions, the development of additional character-driven storylines with greater treatment personalization, translation of content in multiple languages, and the use of additional technological innovation, such as artificial intelligence like natural language processing, to enhance platform interactivity.

A Systematic Review of the Impact of Select Mindfulness Interventions on Psychological Outcomes among Older Adults with Chronic Health Conditions.

OBJECTIVES: Chronic medical conditions can increase the likelihood of experiencing psychological distress and mental health problems among older adults. Mindfulness interventions (MIs) are evidence-based treatment approaches that can improve psychological outcomes. This systematic literature review examines MI studies that focused on older adults (≥60 years old) with chronic health conditions. METHODS: Five databases were systematically searched for intervention studies that involved older adults with chronic health conditions who received acceptance and commitment therapy, mindfulness-based cognitive therapy, or mindfulness-based stress reduction and that included psychological outcomes. RESULTS: A total of 17 studies were identified that met criteria for inclusion. These studies involved interventions for a range of chronic health conditions including chronic pain, stroke, type 2 diabetes, insomnia, cancer, and chronic obstructive pulmonary disease. CONCLUSIONS: Early evidence for MIs impact on psychological outcomes is promising, though more work involving randomized control trials is needed. Current studies generally lack methodological rigor and have a high risk of bias. Given the high rates of chronic pain in older adults and the emerging evidence for MIs, future work in this area is of particular value. CLINICAL IMPLICATIONS: Practitioners should be guardedly optimistic about the value of MIs and ACT for older adults with chronic health conditions.

The Relationship Between Volunteering and the Occurrence of Loneliness Among Older Adults: A Longitudinal Study with 12 Years of Follow-Up.

Informed by the social model of health promotion, this study examined the association between formal volunteering and the occurrence of loneliness among older adults over 12 years of follow-up and whether the association differs by gender. Data came from the Health and Retirement Study (2006-2018). The study sample included 5,000 individuals aged 60 and over who did not experience loneliness in 2006. Self-reported participation in formal volunteer work was classified into three levels: (0) no volunteering, (1) less than 100 hours of volunteering per year, and (2) more than 100 hours of volunteering per year. Cox regression was used to examine the relationship between volunteering level and the onset of loneliness during the 12 years of follow-up. Volunteering more than 100 hours per year was associated with a lower risk of loneliness compared to non-volunteers (HR = 0.55, p = .008). This protective effect was not observed for those who volunteered less than 100 hours per year (HR = 0.84, p = .246). The benefits of volunteering in mitigating loneliness did not differ by gender. Engagement in moderate to high levels of volunteering can protect against loneliness. More volunteering programs can be offered to older adults to reduce loneliness in later life.

The Reciprocal Relationship of Physical Capacity and Mental Health: A Random Intercept Cross-Lagged Panel Model Analysis.

This study investigates the mutual influence of mental health and physical capacity in older adults, considering potential gender differences. Data from 7,504 Medicare beneficiaries aged 65+ from the NHATS 2011-2015 surveys were analyzed using a random intercept cross-lagged panel model in Mplus. Results revealed moderate within-person effects of physical capacity on mental health (ßt12 = -.19, ßt23 = -.32, ßt34 = -.42, ßt45 = -.40), while the reverse relationship showed smaller effects (ßt12 = -.02, ßt23 = -.03, ßt34 = -.03, ßt45 = -.02). Gender differences emerged, with the influence of mental health on physical capacity being significant in men but not women. Additionally, correlations between changes in physical capacity and mental health were stronger for men. Lastly, lagged effects of physical capacity on mental health were notably stronger than the reverse. The findings suggest that enhancing physical capacity may alleviate depression and anxiety symptoms in older adults, particularly men.

Public Discourse and Sentiment Toward Dementia on Chinese Social Media: Machine Learning Analysis of Weibo Posts.

BACKGROUND: Dementia is a global public health priority due to rapid growth of the aging population. As China has the world's largest population with dementia, this debilitating disease has created tremendous challenges for older adults, family caregivers, and health care systems on the mainland nationwide. However, public awareness and knowledge of the disease remain limited in Chinese society. OBJECTIVE: This study examines online public discourse and sentiment toward dementia among the Chinese public on a leading Chinese social media platform Weibo. Specifically, this study aims to (1) assess and examine public discourse and sentiment toward dementia among the Chinese public, (2) determine the extent to which dementia-related discourse and sentiment vary among different user groups (ie, government, journalists/news media, scientists/experts, and the general public), and (3) characterize temporal trends in public discourse and sentiment toward dementia among different user groups in China over the past decade. METHODS: In total, 983,039 original dementia-related posts published by 347,599 unique users between 2010 and 2021, together with their user information, were analyzed. Machine learning analytical techniques, including topic modeling, sentiment analysis, and semantic network analyses, were used to identify salient themes/topics and their variations across different user groups (ie, government, journalists/news media, scientists/experts, and the general public). RESULTS: Topic modeling results revealed that symptoms, prevention, and social support are the most prevalent dementia-related themes on Weibo. Posts about dementia policy/advocacy have been increasing in volume since 2018. Raising awareness is the least discussed topic over time. Sentiment analysis indicated that Weibo users generally attach negative attitudes/emotions to dementia, with the general public holding a more negative attitude than other user groups. CONCLUSIONS: Overall, dementia has received greater public attention on social media since 2018. In particular, discussions related to dementia advocacy and policy are gaining momentum in China. However, disparaging language is still used to describe dementia in China; therefore, a nationwide initiative is needed to alter the public discourse on dementia. The results contribute to previous research by providing a macrolevel understanding of the Chinese public's discourse and attitudes toward dementia, which is essential for building national education and policy initiatives to create a dementia-friendly society. Our findings indicate that dementia is associated with negative sentiments, and symptoms and prevention dominate public discourse. The development of strategies to address unfavorable perceptions of dementia requires policy and public health attention. The results further reveal that an urgent need exists to increase public knowledge about dementia. Social media platforms potentially could be leveraged for future dementia education interventions to increase dementia awareness and promote positive attitudes.

Cyclic Phenylmethylsiloxane Oligomers in Municipal Landfills and Their Elimination Mechanisms in Leachate Treatment Processes.

This study investigated some sources and elimination mechanisms of phenylmethylsiloxanes in landfill leachates. During a 20-day leaching experiment for electronic wastes collected from one Chinese landfill, significant release (4.9 ng/L to 1.3 µg/L) of cis-/trans-2,4,6-triphenyl-2,4,6-trimethylcyclotrisiloxanes (cis-P3 and trans-P3) and cis-/trans-2,4,6,8-tetraphenyl-2,4,6,8-tetramethylcyclotetrasiloxanes (cis-P4 and trans-P4a,b,c) in simulated leachates was found. From January 2017 to December 2018, P3 and P4 isomers were detected in raw leachates from active cells [

Childhood adversity and major depression in later life: A competing-risks regression analysis.

OBJECTIVES: This study examined the relationship between childhood adversities and major depression in older adults over 8 years. METHODS: The study sample consisted of 16 946 participants aged 51 years and older from the US Health and Retirement Study. Major depression was assessed using the Composite International Diagnostic Interview. Competing-risks regression analysis was conducted to examine the impact of each childhood adversity on late-life major depression and the potential moderation effects of sex, race/ethnicity, and adulthood trauma. RESULTS: After controlling for covariates, childhood adversities including physical abuse by a parent (subdistribution hazard ratio [SHR] = 1.67, 95% confidence interval [CI] = 1.49-1.89, P < .001), trouble with the police (SHR = 1.31, 95% CI = 1.13-1.54, P = .001), receiving help because of financial difficulties (SHR = 1.17, 95% CI = 1.05-1.31, P = .006), and parental substance abuse (SHR = 1.11, 95% CI = 1.01-1.23, P = .037) were associated with a higher rate of major depression in later life. The association of physical abuse and major depression was stronger for men than women (SHR = 1.46, 95% CI = 1.15-1.85, P = .002), despite an overall lower risk of major depression among men. Potential adulthood trauma had a weaker association with late-life major depression in the presence of childhood physical abuse (SHR = 0.91, 95% CI = 0.85-0.98, P = .015). There was a significant dose-response relationship (SHR = 1.20, 95% CI = 1.16-1.24, P < .001). CONCLUSIONS: Childhood adversities increase the risk of major depression in later life, particularly for those who experienced physical abuse and trouble with the police. Men may be more susceptible to the mental health detriments of childhood adversities.

Review of recent findings on occurrence and fates of siloxanes in environmental compartments.

In view of their vast global usage in both consumer products and industrial processes, environmental emission and fates of siloxanes have become concerned issue. This review summarized the research progress, especially in the last decade, on production/consumption data, toxicities, analysis methods, environmental distribution, migration and degradation/transformation of both dimethylsiloxanes and modified siloxanes in atmospheric, aquatic and terrestrial compartments from various areas (especially in China). In spite of their fast degradation (hydrolysis and hydroxylation, etc) in various matrices (except sediment), dimethylsiloxane oligomers have been found in various environmental matrices from many countries due to their constant usage and emission. Moreover, recent literatures have paid attention to behaviors of dimethylsiloxanes in industrial areas, e.g., their higher residual levels compared with residential areas and unique transformed products (such as halogenated products) arose from special industrial production scenarios. Meanwhile, although most prior studies focused on dimethylsiloxanes, identification of modified-siloxanes with other functional groups in environment have been beginning to attract the attention of scientists. Furthermore, related literatures indicated that compared with dimethylsiloxanes, both halogenated-dimethylsiloxanes and modified methylsiloxanes (phenylsiloxanes and trifluoropropylsiloxanes) could have stronger persistence due to their weaker volatilization and degradation, especially in terrestrial matrices.

Methylsiloxanes and Their Brominated Products in One e-Waste Recycling Area in China: Emission, Environmental Distribution, and Elimination.

The present study investigated the sources and fates of methylsiloxanes and their brominated products in one e-waste recycling area of China. During thermal (30-1000 °C) recycling experiments for printed wiring boards (PWBs), besides volatile methylsiloxanes (D4, D5, and D6), their monobrominated products, that is, D3D(CH2Br), D4D(CH2Br), and D5D(CH2Br), were also found by quadrupole time-of-flight gas chromatography-mass spectrometry to have 2-3 orders of magnitude lower emissions (0.31-1.3 µg/g) than those (18.1-866 µg/g) of parent methylsiloxanes. Overall, the fastest emissions of methylsiloxanes and bromo-methylsiloxanes occurred at 300-400 and 400-500 °C, respectively, accounting for 35.3-51.0 and 39.4-82.1% of their total emission. In the e-waste recycling area, concentrations of D4-D6 were 1.1-75.0 µg/g dw [detection frequency (df) = 100%] in 31 dusts from PWB treatment workshops, while limits of detection (LOD) < 683 ng/g dw (df = 69-100%) in 48 surrounding soils were up to 3 orders of magnitudes higher than those in reference areas. Meanwhile, D3D(CH2Br)-D5D(CH2Br) were detected in both dusts (

Perceptions and practice behaviors regarding late-life depression among private duty home care workers: a mixed-methods study.

Background: This study aimed to examine personal care aides (PCAs)' knowledge, beliefs, and attitudes towards late-life depression and their experience caring for older adults with depression.Method: This study used a mixed-methods convergent parallel design involving an online survey (n = 87) and semi-structured interviews (n = 22). Survey respondents were recruited using convenience sampling and interviewees using purposive sampling from private duty home care agencies in Michigan. Qualitative data analyzed using a technique involving data reduction and open coding. Survey data were analyzed using descriptive statistics.Results: Most PCAs underestimated suicide rate among older adults, overrated self-help ability of the depressed person, underrated difficulty diagnosing depression, and attributed depression to personality flaws. PCAs favored psychotherapy and informal support and generally regarded medication as unhelpful, particularly in mild/moderate depression. Despite these discordances, PCAs' self-reported practice behaviors included strategies (i.e., communication, behavioral, cognitive, emotional regulation, relational, and external) that were largely consistent with the scientific view, particularly relating to behavioral activation. A prominent theme from PCAs' narratives was individualized care, reflected in their assessment of depressive symptoms, attitude towards depression treatment, and strategies caring for clients.Conclusions: Several areas of PCAs' perceptions regarding late-life depression were discordant with the current scientific view, although their practice behaviors were largely consistent with the principles of evidence-based practice for depression. Specialized mental health training, a standard depression care protocol, and higher training standards are essential to mobilize the large number of PCAs to improve the mental health outcomes of hard-to-reach older adults.

Internet-delivered cognitive behavioral therapies for late-life depressive symptoms: a systematic review and meta-analysis.

Background: This study aimed to review and synthesize evidence related to the effectiveness of internet-based cognitive behavioral therapy (iCBT) for reducing depressive symptoms in older adults.Method: The authors conducted a systematic review of intervention studies testing iCBT for symptoms of depression in older adults. An initial search of PubMed, PsychINFO, and Web of Science was undertaken, followed by a manual search of reference lists of the relevant articles. The Cochrane Risk of Bias Tool was used to appraise study quality. The mean effect size for included studies was estimated in a random effects model. Meta-regression was used to examine potential moderators of effect sizes.Results: Nine studies met the inclusion criteria, including 1272 participants averaging 66 years of age. The study design included randomized controlled trials (k = 3), controlled trials without randomization (k = 2), uncontrolled trials (k = 2), and naturalistic evaluation (k = 2). Seven studies tested iCBT with some level of therapist involvement and 2 examined self-guided iCBT. Six studies tested interventions specifically adapted for older adults. The mean within-group effect size was 1.27 (95% CI = 1.09, 1.45) and the mean between-group effect size was 1.18 (95% CI = 0.63, 1.73). Participants' age was negatively associated with within-group effect sizes (b = -0.06, p = .016).Conclusions: iCBT is a promising approach for reducing depressive symptoms among older adults with mild to moderate depressive symptoms. However, studies involving older adults in iCBT trials were limited, had considerable heterogeneity, and were of low quality, calling for more studies with rigorous designs to produce a best-practice guideline.

Disability type, depression, and antidepressants use among older adults in the United States.

Objectives: The study aimed to estimate the prevalence of depression and antidepressant use among older adults with different types of disability.Methods: The study sample consisted of 32,193 adults 50 years and older who participated in the Adult Functioning and Disability supplement of the National Health Interview Survey from 2010-2014. Logistic regression was used to estimate depressive symptoms and self-reported antidepressant use by disability type.Results: One in ten participants reported feeling depressed daily or weekly, and less than half of them reported using antidepressants. Adults with a disability in cognition (odds ratio [OR] = 5.55), mobility (OR = 1.92), vision (OR = 1.91), hearing (OR = 1.88), and self-care (OR = 1.66) were more likely to often feel depressed. Antidepressant use was higher among those with cognition and self-care disability compared with no disabilities. A dose-response association existed between the number of disabilities and depression (AOR = 2.3) and antidepressant use (AOR = 1.39).Conclusions: Various forms of disability are strongly associated with depression in older adults. Antidepressants may be underutilized among older adults with certain impairments, including vision, hearing, and mobility. Future research needs should elucidate the mechanisms linking different disabilities to depression and aim to develop treatments tailored to the needs of older adults with disabilities.

How the Daily Smartphone is Associated With Daily Travel, Physical Activity, and Self-Perceived Health: Evidence From 2017 National Household Travel Survey.

Knowledge of how smartphone use in daily life, rather than in the context of intervention, may influence people's behaviors and health is limited and mixed. The 2017 National Household Travel Survey (NHTS) data were used to examine the associations between daily smartphone use and several outcomes, including engaging in vigorous physical activity, self-perceived being healthy, and the adjusted mean differences for total trips and active travels among older adults (≥65 years) as well as among young and middle-aged groups (18-64 years), respectively. The prevalence of daily smartphone use declined with increasing age. Daily smartphone use was associated with increased total trips and active travel, a higher likelihood of engaging in vigorous physical activity, and in self-perceived being healthy status. The associations were stronger among older adults than young and middle-aged adults. More studies are needed to address the complex pathways among daily smartphone use and other outcomes. Daily smartphone use has the potential to address the unmet daily needs of older adults and bridge health disparities for this disadvantaged group.

Trajectories of major depression in middle-aged and older adults: A population-based study.

OBJECTIVES: This study aimed to examine depression trajectories and correlates in a nationally representative sample of middle-aged and older adults in the United States. METHODS: The study sample consisted of 15 661 participants aged over 50 years from the US Health and Retirement Study. Major depression was assessed using the Composite International Diagnostic Interview (CIDI-SF). Depression trajectories were identified using a group-based trajectory modeling enhanced to account for nonrandom attrition. Multinomial logistic regression was conducted to investigate predictors of depression trajectories. RESULTS: Four depression trajectory groups were identified: "never" (85.8%), "increasing" (6.3%), "decreasing" (3.2%), and "persistently moderate/high" (4.7%). Baseline depressive symptom severity was a strong predictor of depression trajectories. Older age, male sex, and non-Hispanic African American race were associated with a lower risk of the three trajectories with small to high depression burden, whereas chronic disease count was associated with a higher risk of these trajectories. The risk of being on the increasing trajectory increased with mobility difficulties. Difficulties in household activities predicted membership in the persistently moderate/high group. CONCLUSIONS: A small but nonignorable proportion of middle-aged and older adults have chronic major depression. Initial symptom severity and chronic disease burden are consistent risk factors for unfavorable depression trajectories and potential targets for screening and intervention.

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois.

This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.

Social work-based transitional care intervention for super utilizers of medical care: a retrospective analysis of the bridge model for super utilizers.

The present study was a retrospective evaluation of a social worker-led transitional care intervention that addresses the medical and social needs of inpatient super utilizers with ≥5 inpatient admissions in a 12-month period. Bivariate analyses revealed significant reductions in the total number of hospital admissions, 30-day readmission rates, number of emergency department visits, average hospital charges per episode, and total hospital charges per person after the intervention. This social work intervention may be of interest to providers and payers, particularly regarding addressing the psychosocial needs of complex patients who account for most of health care costs.