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Valuation of Life as outcome and mediator of a depression intervention for older African Americans: the Get Busy Get Better Trial
Author(s) -
Gitlin Laura N.,
Parisi Jeanine M.,
Huang Jin,
Winter Laraine,
Roth David L.
Publication year - 2018
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4710
Subject(s) - optimism , randomized controlled trial , clinical psychology , psychology , mood , referral , depressive symptoms , life satisfaction , medicine , psychiatry , anxiety , psychotherapist , family medicine
Objective Previously, we showed that Get Busy Get Better (GBGB), a 10‐session multicomponent home‐based, behavioral intervention, reduced depressive symptom severity in older African Americans. As appraising the value of life is associated with depressive symptoms, this study examined whether GBGB enhanced positive appraisals of life and if, in turn, this mediated treatment effects on depressive symptoms. Methods Data were from a single‐blind parallel randomized trial involving 208 African Americans (≥55 years old) with depressive symptoms (Patient Health Questionnaire, PHQ‐9 ≥5). GBGB involved five components: care management, referral/linkage, stress reduction, depression education, and behavioral activation. A 13‐item Valuation of Life (VOL) scale with two subfactors (optimism and engagement) was examined as an outcome and as mediating GBGB effects on PHQ‐9 scores at 4 months. Results Of 208 enrolled African Americans, 180 completed the 4‐month interview (87 = GBGB; 93 = control). At 4 months, compared with wait‐list control group participants, the GBGB group had improved VOL (difference in mean changes from baseline = 4.67, 95% confidence interval 2.53, 6.80). Structural equation models indicated that enhanced VOL mediated a significant proportion of GBGB's impact on depressive symptoms, explaining 71% of its total effect, and its subfactors (optimism, explaining 67%; engagement, 52%). Conclusion Valuation of Life appears malleable through an intervention providing resources and activation skills. GBGB's impact on depressive symptoms is attributed in large part to participants' enhanced attachment to life. Attention to VOL as mediator and outcome and the reciprocal relationship between mood and attachment to life is warranted. Copyright © 2017 John Wiley & Sons, Ltd.