title: Valuation of Life as outcome and mediator of a depression intervention for older African Americans: the Get Busy Get Better Trial.
abstract: OBJECTIVE
  Previously, we showed that Get Busy Get Better (GBGB), a 10-session multicomponent home-based, behavioral intervention, reduced depressive symptom severity in older African Americans. As appraising the value of life is associated with depressive symptoms, this study examined whether GBGB enhanced positive appraisals of life and if, in turn, this mediated treatment effects on depressive symptoms.
  
  
  METHODS
  Data were from a single-blind parallel randomized trial involving 208 African Americans (≥55 years old) with depressive symptoms (Patient Health Questionnaire, PHQ-9 ≥5). GBGB involved five components: care management, referral/linkage, stress reduction, depression education, and behavioral activation. A 13-item Valuation of Life (VOL) scale with two subfactors (optimism and engagement) was examined as an outcome and as mediating GBGB effects on PHQ-9 scores at 4 months.
  
  
  RESULTS
  Of 208 enrolled African Americans, 180 completed the 4-month interview (87 = GBGB; 93 = control). At 4 months, compared with wait-list control group participants, the GBGB group had improved VOL (difference in mean changes from baseline = 4.67, 95% confidence interval 2.53, 6.80). Structural equation models indicated that enhanced VOL mediated a significant proportion of GBGB's impact on depressive symptoms, explaining 71% of its total effect, and its subfactors (optimism, explaining 67%; engagement, 52%).
  
  
  CONCLUSIONS
  Valuation of Life appears malleable through an intervention providing resources and activation skills. GBGB's impact on depressive symptoms is attributed in large part to participants' enhanced attachment to life. Attention to VOL as mediator and outcome and the reciprocal relationship between mood and attachment to life is warranted. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Center for Innovative Care in Aging School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Laura N
authors.identifier: http://orcid.org/0000-0003-2869-473X
authors.initials: LN
authors.lastname: Gitlin
authors.affiliation: Principal Faculty, Center for Innovative Care in Aging, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Parisi
authors.affiliation: Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Jin
authors.initials: J
authors.lastname: Huang
authors.affiliation: School of Nursing, Villanova University, Villanova, PA, USA.
authors.forename: Laraine
authors.initials: L
authors.lastname: Winter
authors.affiliation: Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
mesh_terms: D000339:Affect; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000375:Aging / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D026712:Value of Life
keywords: attachment to life; behavioral treatment; depression; mediation analysis