Increasing Use of Mental Health Services (OpenDoor)

Weill Cornell Medicine (WCM)

Status: Completed

Conditions: Major Depression

Treatments: Behavioral: Open Door intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT00605358

R01MH079265-01A1

Details and patient eligibility

About

The purpose of this study is to test the effectiveness of Open Door (previously known as the Treatment Initiation Program [TIP]), a brief psychosocial intervention to address the psychological barriers to care and improve the use of mental health services by depressed community elderly. The intervention is designed to help the older adult identify the barriers, problem-solve to find solutions and mobilize the motivation to seek help. Open Door was developed to work collaboratively with an older adult who is depressed to improve access and adherence to mental health treatment.

Full description

The primary aim of this research study did not change from the original application; it is to conduct a randomized controlled trial of the effectiveness of a brief, psychosocial intervention on engagement in mental health care among homebound depressed older adults. Engagement is defined as accepting a referral and attending a visit with a provider who could provide traditional mental health care (medication or psychotherapy). The intervention, now called Open Door, was developed to work collaboratively with an older adult who has depressive symptoms to address the barriers to care with the aim of helping them consider a referral and engage in mental health care. In prior research, this intervention has been found to improve treatment participation, reduce depressive symptoms and increase adherence to antidepressant therapy among depressed older adults in primary care and outpatient psychiatric settings. We propose that Open Door will improve the access to mental health care by reducing psychological barriers, providing education about care, and managing the resignation associated with the symptoms of depression among community dwelling depressed elders. Additionally, we believe that despite the heterogeneity of mental health care that may be received, Open Door will be associated with reduced depressive symptoms by empowering the older adult to initiate care for him/herself.

Enrollment: 161 patients

Sex: All

Ages: 60 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 60 years and older
• Homebound
• Endorse depressive symptoms

Exclusion criteria

• Presence of significant alcohol or substance abuse or psychotic disorder
• High suicide risk, i.e. intent or plan to attempt suicide
• Cognitive impairment
• Inability to speak English
• Aphasia interfering with communication.
• Current use of antidepressants or psychotherapy

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

161 participants in 2 patient groups

Open Door Intervention

Active Comparator group

Description:

Subjects who receive the Open Door Intervention will work with the study counselor to identify barriers to participation in mental health treatment, set goals, and problem-solve, in addition to receiving a referral.

Treatment:

Behavioral: Open Door intervention

Services Referral

No Intervention group

Description:

Subjects who do not receive the Open Door intervention will receive: 1. an evaluation 2. referral to a local mental health provider 3. booklet information on depression and mental health care, and will complete an application for HEAP, a Westchester County service that provides reduced rates from oil companies on heating to seniors.