A randomized trial of depression assessment intervention in home health care.
OBJECTIVE
To determine whether an educational intervention would improve depression assessment and appropriate referral. Secondary analyses tested whether referral led to depression improvement.


METHODS
Training in the Assessment of Depression (TRIAD) was a three-group, nurse-randomized trial. Researchers interviewed randomly selected patients at baseline and 8 weeks.


METHODS
Three certified home healthcare agencies in Westchester County, New York.


METHODS
Fifty-three medical/surgical nurses were randomized within agency to three intervention groups: full, minimal, or control. Research contact with nurses' patients (aged >65; N=477) yielded 256 (53.7%) enrolled subjects, 84 (17.6%) ineligibles, and 120 (25.2%) refusals; 233 of the 256 (87.1%) enrolled patients completed follow-up interviews.


METHODS
Nurse training in clinically meaningful use of depression sections of Medicare's mandatory Outcome and Assessment Information Set (OASIS).


METHODS
Nurse-assessed mood or anhedonia (OASIS) versus research assessments using the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Disorders (SCID); referrals for mental health evaluation (agency records), and depression severity (24-item Hamilton Depression Rating Scale; HDRS).


RESULTS
Referral rates for patients with (SCID) depressed mood or anhedonia (n=75) varied according to nurse group: 50.0% full intervention, 18.5% minimal, 21.4% control (P=.047). Rates for nondepressed patients (n=180) did not differ (4.9%, 2.0%, 5.8%, respectively; P=.60). In patients with major or minor depression (n=37), referral was associated with symptom improvement. Change in HDRS was 5 points greater in referred patients than others (P=.04). Concordance between OASIS and SCID did not differ between intervention groups.


CONCLUSIONS
TRIAD showed that training nurses to assess for depression using an approach developed in partnership with home healthcare agencies led to appropriate referral and care for depressed patients.
Bruce
Martha L
ML
Department of Psychiatry, Weill Medical College of Cornell University, White Plains, New York, USA. mbruce@med.cornell.edu
Brown
Ellen L
EL
Raue
Patrick J
PJ
Mlodzianowski
Amy E
AE
Meyers
Barnett S
BS
Leon
Andrew C
AC
Heo
Moonseong
M
Byers
Amy L
AL
Greenberg
Rebecca L
RL
Rinder
Susan
S
Katt
Wendy
W
Nassisi
Pamela
P
D000368:Aged; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003479:Curriculum; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006699:Home Care Services; D006801:Humans; D007318:Inservice Training; D008297:Male; D009518:New York; D009730:Nursing Assessment; D010552:Personality Assessment; D012017:Referral and Consultation