Abstract

Objectives: To describe reasons for refusal to be referred to or enroll in a depression treatment study and post-enrollment challenges to treatment engagement and technology-related problems among low-income homebound individuals aged 50+ years with depression.

Methods: Data came from a 3-arm randomized clinical trial that evaluated real-world effectiveness of lay counselor-delivered behavioral activation (BA) versus clinician-delivered problem-solving therapy (PST). Interventionists were embedded in a large home-delivered meals program and treatment sessions were videoconferenced; hence Tele-BA and Tele-PST. We described refusal reasons of those who refused initial case manager referrals (n = 279), telephone screening (n = 64), enrollment (n = 47), or post-enrollment baseline assessments (n = 18). We used inductive thematic analysis to explore challenges to effectual treatment engagement and tele-delivery-related problems among Tele-PST or Tele-BA participants (n = 183) from the interventionists’ tele-session process recordings.

Results: More than a third of potentially eligible older adults refused their case managers’ referral, and a quarter of those who accepted referral refused further screening or enrollment. Three quarters of those who refused reported no interest or need or declined to talk about depression. Others refused given their busy schedule with medical appointments and caregiving. Nearly 80% of Tele-BA or Tele-PST participants had some challenges to effectual engagement in treatment sessions due to environmental and health-related conditions and other life stressors including financial distress. Though many tele-sessions had connectivity and other technology-related problems, these did not affect depression outcomes.

Conclusion: Mental health service providers for low-income older adults need to be aware of these challenges when adopting best practice strategies for them.

摘要

目的：描述拒绝转介或参加抑郁症治疗研究的原因，以及在 50 岁以上的低收入家庭抑郁症患者中对治疗参与和技术相关问题的入学后挑战。

方法：数据来自一项 3 臂随机临床试验，该试验评估了外行辅导员提供的行为激活 (BA) 与临床医生提供的问题解决疗法 (PST) 的真实效果。干预人员被安排在一个大型的家庭送餐计划中，治疗会议通过视频会议进行；因此 Tele-BA 和 Tele-PST。我们描述了拒绝初始个案经理转介（n  = 279）、电话筛选（n  = 64）、注册（n  = 47）或注册后基线评估（n  = 18）的人的拒绝原因。我们使用归纳主题分析来探索在 Tele-PST 或 Tele-BA 参与者中有效治疗参与和远程交付相关问题的挑战 ( n = 183) 来自干预者的远程会议过程记录。

结果：超过三分之一的可能符合条件的老年人拒绝了他们的个案经理的转介，而接受转介的人中有四分之一拒绝进一步筛查或登记。四分之三拒绝的人表示没有兴趣、不需要或拒绝谈论抑郁症。其他人则拒绝了，因为他们忙于预约医疗和护理。近 80% 的 Tele-BA 或 Tele-PST 参与者由于环境和健康相关条件以及其他生活压力因素（包括经济困难）而在有效参与治疗过程中遇到一些挑战。尽管许多电话会议存在连接问题和其他与技术相关的问题，但这些问题并不影响抑郁症的结果。

结论：低收入老年人的心理健康服务提供者在为他们采用最佳实践策略时需要意识到这些挑战。