title: Design and Recruitment for a Randomized Controlled Trial of Problem-Solving Therapy to Prevent Depression among Older Adults with Need for Supportive Services.
abstract: OBJECTIVE
  Addressing subthreshold depression (indicated prevention) and vulnerabilities that increase the risk of major depression or anxiety disorders (selective prevention) is important for protecting mental health in old age. The Depression-Agency Based Collaborative (Dep-ABC) is a prevention trial involving older adults recruited from aging services sites (home care agencies, senior housing, senior centers) who meet criteria for subthreshold depression and disability. Therefore, the authors examine the effectiveness of partnerships with aging services sites for recruiting at-risk older adults, the quality of recruitment and acceptability of the Dep-ABC assessment and intervention, and the baseline status of participants.
  
  
  METHODS
  Dep-ABC is a single-blind randomized controlled prevention trial set in aging services settings but with centralized screening, randomization, in-home assessments, and follow-up. Its intervention arm involves six to eight sessions of problem-solving therapy, in which older adults aged 60+ learn to break down problems that affect well-being and develop strategies to address them. We examined participation rates to assess quality of recruitment across sites and level of disability according to service use.
  
  
  RESULTS
  Dep-ABC randomized 104 participants, 68.4% of eligible older adults. Screening using self-reported disability successfully netted a sample in which 74% received home care agency services, with remaining participants similarly impaired in structured self-reports of impairment and on observed performance tests.
  
  
  CONCLUSIONS
  Direct outreach to aging services providers is an effective way to identify older adults with service needs at high risk of major depression. Problem-solving therapy is acceptable to this population and can be added to current services.
authors.affiliation: Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Albert
authors.affiliation: Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: King
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Begley
authors.affiliation: Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Stewart
authors.initials: S
authors.lastname: Anderson
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Karp
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ari
authors.initials: A
authors.lastname: Gildengers
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Meryl
authors.initials: M
authors.lastname: Butters
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: ReynoldsCF@upmc.edu.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000517:prevention & control*; D003865:Major Depressive Disorder / Q000517:prevention & control*; D004185:Disability Evaluation; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008603:Mental Health; D018579:Patient Selection; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D012107:Research Design; D016037:Single-Blind Method
keywords: caregiving; depression; disability; older adults; prevention; problem-solving therapy