LOW INCOME OLDER ADULTS' PERCEPTIONS, PRIORITIES AND PREFERENCES FOR DEPRESSION TREATMENT
Martha Shumway, PhD1, Leslie Hasche, LCSW2, Enola Proctor2, Nancy Morrow-Howell2, and Deanna Davidson2. (1) University of California, San Francisco, San Francisco, CA, (2) Washington University in St. Louis, St. Louis, MO
Purpose: Low income older adults suffer disproportionately high levels of depression, yet are unlikely to receive depression treatment. This study examined older adults' perceptions of depression, priorities for addressing problems with depression, and preferences for depression treatment to inform the design of acceptable and effective intervention models. Methods: In-depth mixed-method interviews were conducted with 50 participants from a completed epidemiological study of older adults in public community long-term care (CLTC). All were above the age of 60, had received CLTC services, and had subthreshold depressive symptoms during the initial study. For analysis, five members of the research team identified and labeled potential themes and developed coding categories using NVivo data analysis software. Results: The sample was predominantly female. Participants had mild to moderate current depression (Patient Health Questionnaire, mean: 10.41, SD = 5.12). Participants generally recognized and acknowledged their depression. They did not, however, see depression as a high priority in relation to their other life problems, such as physical illness, pain, loneliness, finances and family problems. Participants voiced conceptualizations consistent with a “social model” of depression, viewing depression as interconnected with their other life problems, particularly physical health, physical functioning and social support. Similarly, participants believed that addressing depression would impact other problem areas and that addressing other problem areas would alleviate depression. Participants expressed a general interest in help for their depression and a willingness to try standard treatments such as self-help materials, individual treatment with a primary care provider, and group treatment. Few participants expressed interest in individual treatment with a specialty mental health care provider. Participants with prior experience with depression treatment tended to view those experiences negatively and tended to be less interested in seeking additional treatment. Conclusions: This assessment of low income older adults' perceptions, priorities and preferences for depression treatment indicates that depressed older adults recognize that they are depressed and are interested in treatment. However, since low income older adults see their depression symptoms as inextricably linked to their other significant medical and social problems, intervention models should conceptually address depression in a broad social context and practically link depression treatment with other medical and social services.