Community LTC Service & Outcomes: Burden of Depression
(Also know as WELL-BEING IN COMMUNITY CARE STUDY)

Principal Investigator: Nancy Morrow-Howell, Ph.D. & Enola Proctor, Ph.D.
Funder:  National Institute on Aging, R01 (5R01AGO17451)
Timeframe: Funded 6/00 - 5/05
Affiliation: Center for Mental Health Services Research (CMHSR)

                                   

   RA Leewa Khatiwada copying DSS records        Lisa, Ashley, Christine, Sunha-record collection in SEMO           RA Christine Tengey entering record data

• Lee Robins, Ph.D., Professor of Social Science in Psychiatry, Investigator
• Sally Haywood, MPA, Administrator for the CMHSR
• Lisa Lawrence, MSW, Project Coordinator
• Sunha Choi, MSW, Ph.D. Student
• Edward Spitznagel, Ph.D., Professor of Mathematics, Biostatistician
• Peter Dore, MA, Data Manager, Center for Mental Health Services Research
• Wayne Blinne, MA, Data Manager/Analyst, Center for Mental Health Services Research

Participating Organizations: State of Missouri, Division of Senior Services
Project Contact: Lisa Lawrence - Project Coordinator
                            Phone- (314) 935-8636, (877) 778-6449
                            Fax- (314) 935-8781, (877)770-2950
                            Email- Llawrence@wustl.edu

Project Update as of  1/12/04
Stage The study has collected data from 1,789 community long-term care (CLTC) clients.

Baseline Findings:  Description of  Missouri CLTC Clients (1,100 clients interviewed)
    Gender: 77% female
    Average Age: 72
    Race: 28% African American
    Household: 54% live alone
    Marital Status:  50% Widowed, 21% Married, 18% Divorced, 5% Separated, 4% Never Married
    Top 5 Medical Conditions Reported:
         1.    Arthritis or Rheumatism = 80%
         2.    High Blood Pressure or Hypertension = 72%
         3.    Glaucoma, cataracts, other eye problem = 50%
         4.    Heart trouble = 49.8%
         5.    Diabetes = 35%

Reports

Key Findings

• 7% of study sample have a current major depression, and 19% have subthreshold depression, with high depressive symptoms. 
• Attitudes about mental health from the depressed group only:
  • 77.47% think a mental health professional would understand their problems
  • 90.81% would seek treatment for a mental health problem
  • 35.66% think one should handle mental problems by self
  • 74.38% perceived their family doctor as helpful
  • 53.38% perceived their clergy to be as useful as talking to a mental health specialist. 

• Barriers to mental health treatment from the depressed group only:

  • 58.22% reported not knowing where to obtain treatment for mental health problems

  • 82.42% reported that the cost of treatment would be more than one could afford

  • 50.72% reported that they would not consider obtaining treatment if it was far away
• Only 60% of older adults who were depressed upon initial assessment were not depressed persistently for the one-year study period.
• High levels of co-morbid conditions among depressed group respondents:
  • 69% have an illness that limits their activities
  • 84% have arthritis or rheumatism
  • 75% have difficulty walking up and down a flight of stairs
  • 69% eat alone most of the time.

Practice or Policy Implications

• Estimate the extent of depression among elders first entering community long-term care services and identify factors associated with depression.
• Determine the service demand on the CLTC attributable to depression.
• Determine the effects of CLTC services on clients with depression.
• Determine the extent to which depression negatively affects the outcomes attained through in-home services, such as client satisfaction and client functioning.
• Examine how the current in-home service system responds to the mental health needs of its clients.

Description
      This study examined the challenges faced by the growing and evolving sector of community long-term care.  Publicly funded, community long-term care services attempt to address the multiple physical, cognitive, and psychosocial needs of low income elders who have chronic disabling conditions.  Along with these concerns, a disproportionate number of these elders are expected to experience depression since depression is associated with both physical dependency and low income. In general, the community long-term care system has neither the mandate nor the resources to address depression.  Furthermore, literature reviews indicate that little is known about the prevalence of depression in this elderly client population.
      This lack in knowledge and resources is becoming a greater concern as the number of elderly clients in community care increases. Along with estimating the prevalence of depression, research staff will examined how depression impacts the system.  First, depression may be causing an overlooked burden on the service demand.  Second, it may be minimizing the possible benefits that a client could receive from the service system.
To examine these issues, research staff conducted telephone interviews with 2,000 new clients to the Missouri’s community long-term care system, the Division of Senior Services. By collaborating with the Division of Senior Services, researchers had access to a diverse population of rural and urban older adults. Researchers conducted follow-up interviews with 600 elders and tracked their service use through Division of Senior Services records for one year. 

Conference Presentations

“Clinical epidemiology and stakeholder research to inform depression interventions in community long term care.”  Presentation at First National Conference on Geriatric Social Work, Atlanta, February 2003.  Nancy Morrow-Howell.

“Informing the response to depression in community long-term care.” Poster presented at the National Institute of Mental Health Conference, Beyond the clinic walls: Expanding mental health, drug and alcohol services, Washington, D.C., March 10-12, 2003.  Enola Proctor & Nancy Morrow-Howell.

“Clinical epidemiological research to inform depression-interventions in community long-term care.” Paper presented at the Seventh Annual Conference of the Society for Social Work and Research, Washington, D.C., January 16-19, 2003.  Enola Proctor & Nancy Morrow-Howell.

“Stakeholder research to guide intervention development for depressed elders in public community long-term care.” Paper presented at the Seventh Annual Conference of the Society for Social Work and Research, Washington, D.C., January 16-19, 2003.  Enola Proctor & Nancy Morrow-Howell.

“Clinical Epidemiology Research on Depression Interventions in Community Long-Term care.”  Presentation at the NIMH sponsored Moving Forward:  Building on Social Work Contributions to Mental Health Research, Rockville, Maryland, June 10-11, 2002.  Enola Proctor & Nancy Morrow-Howell.

“Clinical epidemiology of depression in community long term care.”  Presentation at Research Conference on Social Work Research, NIMH, Washington, DC, June 2002.  Nancy Morrow-Howell.

“Responding to depression among elders in public community long term care.”  Presented at the NIMH Center Directors Meeting, Pearl River, New York, April 26, 2001.  Enola Proctor & Nancy Morrow-Howell.

"Responding to depression among elders in public community long-term care."  Presentation at the Center Directors Meeting, New York, April 26, 2001.  Enola Proctor

Forthcoming, In Press, or Published Papers