Marriage and other important social relationships as predictors of accessing mental health services and on mental health outcomes among older adults with depression

Objective . Older adults access mental health services at lower rates than younger adults. The effects of marriage and other important social relationships on older adults\u27 accessing mental health services are largely unknown. The purpose of this study was to use an expanded Behavioral Model and social integration theory to examine the effect marriage and other important social relationships have on accessing mental health care by elders with depression. Once study participants entered into mental health care, this study focused on the effect marriage and other social relationships had on the depression outcomes of older adults who participated in mental health treatment. Methods . Study subjects for this research were 1002 depressed older adults age 65 and above who participated in the PRISM-E study, a randomized mental health services trial. Predisposing, enabling and evaluated needs components were entered into a stepwise multivariate logistic regression model to determine the effect marriage and other social relationships had on accessing mental health services. Analysis of variance models were estimated to examine the effect of marriage and other social relationships on depression outcomes at six months compared to baseline scores, using the Center for Epidemiological Studies for Depression (CES-D). Results . Marriage did not have any effect on older adults\u27 accessing mental health treatment, nor did having close relatives. Having close friends or participating in one or more social/recreation groups had a significant, direct effect on accessing mental health services by older adults controlling for evaluated needs. The structural indicators of social relationships had no effect on the depression outcomes of older adults. Men in the treatment group experienced a greater reduction in their CES-D score compared to women. Conclusion . Marriage, a structural indicator of social integration, had no effect on accessing mental health services or on the severity of depression scores among older adults with depression. Use of the Behavioral Model in conjunction with social integration theory is discussed. Implications for future directions in mental health services research are presented

Primary Care Clinicians Evaluate Integrated and Referral Models of Behavioral Health Care For Older Adults: Results From a Multisite Effectiveness Trial (PRISM-E)

BACKGROUND Recent studies have shown that integrated behavioral health services for older adults in primary care improves health outcomes. No study, however, has asked the opinions of clinicians whose patients actually experienced integrated rather than enhanced referral care for depression and other conditions. METHOD The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study was a randomized trial comparing integrated behavioral health care with enhanced referral care in primary care settings across the United States. Primary care clinicians at each participating site were asked whether integrated or enhanced referral care was preferred across a variety of components of care. Managers also completed questionnaires related to the process of care at each site. RESULTS Almost all primary care clinicians (n = 127) stated that integrated care led to better communication between primary care clinicians and mental health specialists (93%), less stigma for patients (93%), and better coordination of mental and physical care (92%). Fewer thought that integrated care led to better management of depression (64%), anxiety (76%), or alcohol problems (66%). At sites in which the clinicians were rated as participating in mental health care, integrated care was highly rated as improving communication between specialists in mental health and primary care. CONCLUSIONS Among primary care clinicians who cared for patients that received integrated care or enhanced referral care, integrated care was preferred for many aspects of mental health care