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Problem-solving training for Veterans in home based primary care: an evaluation of intervention effectiveness

Published online by Cambridge University Press:  18 January 2021

Sherry A. Beaudreau ,
Michele J. Karel ,
Jennifer S. Funderburk ,
Arthur M. Nezu ,
Christine Maguth Nezu ,
Ann Aspnes  and
Julie Loebach Wetherell
Sherry A. Beaudreau*
Affiliation:
Psychiatry Service, Sierra Pacific Mental Illness, Research, Education and Clinical Centers (MIRECC), Veterans Affairs Palo, Alto Health Care System, Palo Alto, CA, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
Michele J. Karel
Affiliation:
Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA
Jennifer S. Funderburk
Affiliation:
VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA Department of Psychiatry, University of Rochester, Rochester, NY, USA
Arthur M. Nezu
Affiliation:
Department of Psychology, Drexel University, Philadelphia, PA, USA
Christine Maguth Nezu
Affiliation:
Department of Psychology, Drexel University, Philadelphia, PA, USA
Ann Aspnes
Affiliation:
Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA
Julie Loebach Wetherell
Affiliation:
Mental Health Service, Home-Based Primary Care, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California, San Diego, CA, USA
*
Correspondence should be addressed to: Sherry A. Beaudreau, Veterans Affairs Palo Alto Health Care System, Psychiatry/MIRECC (151Y), 3801 Miranda Ave, Palo Alto, CA 94304, USA. Phone: +1(650) 493-5000 x64119; Fax: +1(650) 852-3297. Email: sherryb@stanford.edu.
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Abstract

Background:

Veterans enrolled in Veterans Health Administration (VHA) Home Based Primary Care (HBPC), a program providing in-home medical and mental health care by an interdisciplinary care team, often face substantial physical, cognitive, and mental health challenges. This program evaluation examined the impact of a brief problem-solving intervention on depressive symptoms, quality of life, and problem-solving abilities for Veterans enrolled in HBPC.

Design:

Pre- and post-intervention outcomes for Veterans, and qualitative feedback from Veterans and clinicians regarding program satisfaction.

Participants and Setting:

A total of 230 HBPC patients (mean age in years = 72.1, SD = 11.6) within the U.S. national VHA health care system.

Intervention:

Six-session, individual Problem-Solving Training (PST-HBPC).

Method:

Licensed psychologists and social workers (n = 115) completed training and administered the treatment with HBPC Veterans between 2014 and 2017.

Measurements and Results:

From baseline to post-intervention, Veterans completing five or more PST-HBPC sessions (n = 199) reported significant reductions in depressive symptoms on the Patient Health Questionnaire 9-item (PHQ-9), in difficulty functioning due to depressive symptoms (PHQ-9 item 10), and in thoughts of death (PHQ-9 item 9). They also reported more effective problem-solving on the Social Problem-Solving Inventory – Revised: Short form (total score and subscales), and improved quality of life across life domains on the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale. Both clinicians and Veterans also reported satisfaction with the program.

Conclusions:

Preliminary findings support the continued dissemination and implementation of this brief PST intervention for HBPC Veterans, and its potential for use with non-VA home care populations with complex comorbidities.

Keywords

cognitive behavioral therapycommunity caredepression
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Issue 2: Issue Theme: Technology, Virtual Reality, and Other Promising Interventions for Older Adults , February 2022 , pp. 165 - 176
Copyright
© International Psychogeriatric Association 2021

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References

Areán, P. A., Raue, P., Mackin, S., Kanellopoulos, D., McCulloch, C. and Alexopoulos, G. S. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. The American Journal of Psychiatry, 167, 1391–1398. https://doi.org/10.1176/appi.ajp.2010.09091327 CrossRefGoogle ScholarPubMed
Beaudreau, S. A., Rideaux, T. R., O’Hara, R. and Areán, P. (2015). Does cognition predict treatment response in psychotherapy or pharmacotherapy for late-life depression? The American Journal of Geriatric Psychiatry, 23, 215–219. https://doi.org/10.1016/j.jagp.2014.09.003 CrossRefGoogle ScholarPubMed
Bell, A. C. and D’Zurilla, T. J. (2009). Problem-solving therapy for depression: a meta-analysis. Clinical Psychology Review, 29, 348–353. https://doi.org/10.1016/j.cpr.2009.02.003 CrossRefGoogle ScholarPubMed
Choi, N. G., Marti, C. N., Bruce, M. L., Hegel, M. T., Wilson, N. L. and Kunik, M. E. (2014). Six-month postintervention depression and disability outcomes of in-home telehealth problem-solving therapy for depressed, low-income homebound older adults. Depression and Anxiety, 31, 653–661. https://doi.org/10.1002/da.22242 CrossRefGoogle ScholarPubMed
Choi, N. G., Marti, C. N. and Conwell, Y. (2015). Effect of problem-solving therapy on depressed low-income homebound older adults’ death/suicidal ideation and hopelessness. Suicide and Life-Threatening Behavior, 46, 323–336. https://doi.org/10.1111/sltb.12195 CrossRefGoogle ScholarPubMed
D’Zurilla, T. J., Nezu, A. M. and Maydeu-Olivares, A. (2002). Social Problem-Solving Inventory-Revised (SPSI-R). North Tonawanda, NY: Multi-Health Systems, Inc.Google Scholar
Fletcher, T. L., et al. (2018). Recent advances in delivering mental health treatment via video to home. Current Psychiatry Reports, 20, 56. https://doi.org/10.1007/s11920-018-0922-y CrossRefGoogle ScholarPubMed
Gellis, Z. D. and Bruce, M. L. (2010). Problem-solving therapy for subthreshold depression in home healthcare patients with cardiovascular disease. The American Journal of Geriatric Psychiatry, 18, 464–474. https://doi.org/10.1097/jgp.0b013e3181b21442 CrossRefGoogle ScholarPubMed
Gellis, Z. D., McGinty, J., Horowitz, A., Bruce, M. L. and Misener, E. (2007). Problem-solving therapy for late-life depression in home care: a randomized field trial. The American Journal of Geriatric Psychiatry, 15, 968–978. https://doi.org/10.1097/JGP.0b013e3180cc2bd7 CrossRefGoogle ScholarPubMed
Gellis, Z. D. and Nezu, A. M. (2011). Depression treatment for homebound medically ill older adults: using evidence-based Problem-Solving therapy. In: Sorocco, K. and Lauderdale, S. (Eds.), Implementing CBT with Older Adults: Innovations Across Care Settings (pp. 391–420). New York: Springer.Google Scholar
Gillespie, S. M. et al. (2019). Interdisciplinary team perspectives on mental health care in VA home-based primary care: a qualitative study. American Journal of Geriatric Psychiatry, 27, 128–137. https://doi.org/10.1016/j.jagp.2018.10.006 CrossRefGoogle ScholarPubMed
Kanellopoulos, D. et al. (2020). Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits. International Psychogeriatrics, 32, 485–493. https://doi.org/10.1017/S1041610219001716 CrossRefGoogle ScholarPubMed
Karlin, B. E. and Karel, M. J. (2014). National integration of mental health providers in VA home-based primary care: an innovative model for mental health care delivery with older adults. Gerontologist, 54, 868–879. https://doi.org/10.1093/geront/gnt142 CrossRefGoogle ScholarPubMed
Karlin, B. E. and Zeiss, A. M. (2010). Transforming mental health care for older veterans in the Veterans Health Administration. Generations, 34, 74–83.Google Scholar
Karuza, J. et al. (2017). National structural survey of Veterans Affairs home-based primary care programs. Journal of the American Geriatrics Society, 65, 2697–2701. https://doi.org/10.1111/jgs.15126 CrossRefGoogle ScholarPubMed
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R. and Schimmel, H. (1983). Validation of a short orientation-memory-concentration test of cognitive impairment. The American Journal of Psychiatry, 140, 734–739. https://doi.org/10.1176/ajp.140.6.734 Google Scholar
Kiosses, D. N., Ravdin, L. D., Gross, J. J., Raue, P., Kotbi, N. and Alexopoulos, G. S. (2015). Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry, 72, 22–30. https://doi.org/10.1001/jamapsychiatry.2014.1305 CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle ScholarPubMed
Lutz, J. et al. (2020). A case report of problem solving therapy for reducing suicide risk in older adults with anxiety disorders. Clinical Gerontologist, 43, 1–8. https://doi.org/10.1080/07317115.2019.1617378 CrossRefGoogle ScholarPubMed
Lutz, J. and Fiske, A. (2017). Functional disability and suicidal behavior in middle-aged and older adults: a systematic critical review. Journal of Affective Disorders, 227, 260–271. https://doi.org/10.1016/j.jad.2017.10.043 CrossRefGoogle ScholarPubMed
Meiran, N., Stuss, D. T., Guzman, D. A., Lafleche, G. and Willmer, J. (1996). Diagnosis of dementia: methods for interpretation of scores of 5 neuropsychological tests. Archives of Neurology, 53, 1043–1054. https://doi.org/10.1001/archneur.1996.00550100129022 CrossRefGoogle ScholarPubMed
Nezu, A. M. and Nezu, C. M. (2014). Problem-Solving Training Home Based Primary Care: Treatment Manual. Washington, D.C.: Mental Health and Suicide Prevention Services, VA Central Office and US Department of Veteran Affairs.Google Scholar
Nezu, A. M., Nezu, C. M. and D’Zurilla, T. J. (2013). Problem-Solving Therapy: A Treatment Manual. New York, NY: Springer Publishing Company.Google Scholar
Nieuwsma, J. A., Trivedi, R. B., McDuffie, J., Kronish, I., Benjamin, D. and Williams, J. W. (2011). Brief Psychotherapy for Depression in Primary Care: A Systematic Review of the Evidence [Internet]. Washington (DC): Department of Veterans Affairs (US).Google Scholar
O’Hara, R., Beaudreau, S. A., Gould, C. E., Froehlich, W. and Kraemer, H. C. (2017). Handling clinical comorbidity in randomized clinical trials in psychiatry. Journal of Psychiatric Research, 86, 26–33. https://doi.org/10.1016/j.jpsychires.2016.11.006 CrossRefGoogle ScholarPubMed
Pomerantz, A. S. Kearney, L. K. Wray, L. O. Post, E. P. & McCarthy, J. F. (2014). Mental health services in the medical home in the Department of Veterans Affairs: factors for successful integration. Psychological Services, 11, 243–253. https://doi.org/10.1037/a0036638 CrossRefGoogle ScholarPubMed
Rasin-Waters, D., Abel, V., Kearney, L. K. and Zeiss, A. (2018). The integrated care team approach of the Department of Veterans Affairs (VA): geriatric primary care. Archives of Clinical Neuropsychology, 33, 280–289. https://doi.org/10.1093/arclin/acx129 CrossRefGoogle ScholarPubMed
Skevington, S. M., Lotfy, M. and O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13, 299–310. https://doi.org/10.1023/B:QURE.0000018486.91360.00 CrossRefGoogle Scholar
Tenhula, W. N., et al. (2014). Moving forward: a problem-solving training program to foster veteran resilience. Professional Psychology: Research and Practice, 45, 416–424. https://doi.org/10.1037/a0037150 CrossRefGoogle Scholar
The WHOQOL Group (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558. https://doi.org/10.1017/s0033291798006667 CrossRefGoogle Scholar
Zeiss, A. M. and Karlin, B. E. (2008). Integrating mental health and primary care services in the Department of Veterans Affairs health care system. Journal of Clinical Psychology in Medical Settings, 15, 73–78. https://doi.org/10.1007/s10880-008-9100-4 CrossRefGoogle ScholarPubMed