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Effectiveness of Case Management with Problem-Solving Therapy for Rural Older Adults with Depression.

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Case management with problem-solving therapy (CM-PST) significantly reduced depression and disability in rural older adults. These positive outcomes were comparable to those seen in urban populations, demonstrating CM-PST

Keywords:
Depressioncase managementolder adultsproblem solving therapyrural

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Area of Science:

  • Gerontology
  • Psychiatry
  • Public Health

Background:

  • Depression and disability are significant issues for older adults, particularly in rural areas.
  • Existing interventions may not adequately address the unique needs and accessibility challenges faced by rural seniors.
  • Case Management with Problem-Solving Therapy (CM-PST) has shown promise in urban settings.

Purpose of the Study:

  • To evaluate the effectiveness of CM-PST in reducing depression and disability among rural older adults.
  • To compare the outcomes of CM-PST in a rural setting with a previous study conducted in an urban setting.

Main Methods:

  • A comparative study involving 56 rural and 84 urban older adults (aged 60+) with mild to moderate depression.
  • Participants received 12 weekly one-hour home-delivered sessions of CM-PST from a master's-level clinician.
  • Outcomes including depression, disability, unmet needs, resilience, self-efficacy, and hopelessness were assessed.

Main Results:

  • CM-PST significantly reduced depression (13.9 points) and disability (6.7 points) by week 12 in rural older adults, with sustained effects at week 24.
  • The magnitude of reduction in depression and disability in the rural sample was comparable to or better than that observed in the urban sample.
  • Improvements in unmet needs and resilience predicted lower depression scores, while unmet needs and hopelessness predicted disability improvements.

Conclusions:

  • Home-delivered CM-PST is an effective intervention for reducing depression and disability in rural older adults, matching the efficacy seen in urban populations.
  • The intervention can be successfully adapted for rural settings, utilizing resources commonly available within these communities.
  • CM-PST offers a viable and effective approach to improving mental health and functional status for homebound seniors in diverse geographic locations.