title: Improving Mental Health Treatment Initiation among Depressed Community Dwelling Older Adults.
abstract: OBJECTIVE
  Depression screening has been widely implemented in community settings to increase detection of late-life depression. Rates of treatment initiation are low without additional structured follow-up, however. The current study evaluates the effectiveness of a brief psychosocial intervention, Open Door, designed to improve initiation of mental health treatment among clients of aging service meals programs.
  
  
  METHODS
  Older adult social service clients with depressive symptoms were randomized to either the Open Door intervention or a Service Referral control condition. In Open Door, the counselor collaborates with the client to identify and address both attitudinal and structural barriers to seeking mental health treatment. Independent research assessments were conducted 12 and 24 weeks after baseline to document treatment initiation (at least one session).
  
  
  RESULTS
  At follow up, 64.6% (104 out of 161) of participants had initiated a provider visit. Participants in Open Door were more likely to initiate treatment compared with those in the control condition (χ(2) = 5.83, df = 2, p = 0.016). Among participants with at least mild depressive symptoms, Open Door remained significantly more effective than the control condition (p < 0.05). In multivariate analyses controlling for gender differences, both participation in the Open Door group and depression severity predicted treatment initiation (χ(2) = 15.18, df = 3, p = 0.002).
  
  
  CONCLUSIONS
  High rates of depression have been documented among older adults receiving social services (case management or home meals). The Open Door program offers a useful strategy to overcome the barriers to treatment initiation while fitting within the responsibilities of aging service staff. The intervention can improve initiation of late-life depression care.
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY. Electronic address: jsirey@med.cornell.edu.
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Sirey
authors.affiliation: Department of Health Policy and Research, Weill Cornell Medical College, White Plains, NY.
authors.forename: Samprit
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marino
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY.
authors.forename: Ashley
authors.initials: A
authors.lastname: Halkett
authors.affiliation: Department of Clinical Psychology, Long Island University, 1 University Plaza, Brooklyn, NY.
authors.forename: Elmira
authors.initials: E
authors.lastname: Raeifar
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY.
authors.forename: Michelle
authors.initials: M
authors.lastname: Paggi
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling / Q000379:methods*; D003863:Depression / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*
keywords: access to care; depression; mental health intervention; treatment initiation