Problem-Solving Therapy for Subthreshold Depression in Home Healthcare Patients With Cardiovascular Disease

Background: Randomized trial evaluated problem-solving therapy in home care (PST-HC) for homebound older adults with cardiovascular disease receiving acute home care services. This study hypothesized that compared with usual care plus education intervention, home-based PST-HC would significantly reduce depression and anxiety scores, lead to improved quality of life, and greater satisfaction with treatment among elderly with cardiovascular disease. Methods: Thirty-eight participants were recruited from a university-affiliated home healthcare agency for the trial. Six 1-hour PST-HC sessions included depression education, problem-solving skills, pleasurable activity scheduling, homework, and weekly telephone calls over a 6-week period. The control comparison group received usual care plus two sessions of education and a depression brochure. Outcome measures included the Beck Depression Inventory, Hamilton Rating Scale for Depression, Beck Anxiety Inventory, and the short form (SF)-36 health status measure. After the intervention, both groups completed the Patient Satisfaction Questionnaire. Results: Compared with the control group, the PST-HC group showed a significant decrease in depression but not anxiety scores. The PST-HC group generally reported more favorable satisfaction with treatment than the control group. The PST-HC group improved significantly, when compared with the control group in only two of eight SF-36 subscales: mental health and emotional role function. Conclusions: The brief PST-HC intervention demonstrated that depression improved among home care elderly. However, there was no change in six of eight health status measures or anxiety level. Authors discuss integrating interdisciplinary depression care in the home care setting. (Am J Geriatr Psychiatry 2010; 18:464-474)