Effects of a mutual recovery intervention on mental health in depressed elderly community-dwelling adults: a pilot study

Abstract

Background: The prevalence of depression in the elderly is growing worldwide, and the population aging in China makes depression a major health problem for the elderly adults and a tremendous burden to the society. Effective interventions should be determined to provide an approach solving the problem and improving the situation. This study examined the effectiveness of a mutual recovery program intervention on depressive symptom, sleep quality, and well-being in community-dwelling elderly adults with depressive symptom in Shanghai.

Methods: Recruitment was performed between July 2012 and August 2012. Using a cluster randomized wait-list controlled design, we randomized 6 communities (n = 237) into either the intervention group (3 communities, n = 105) or to a wait-list control group (3 communities, n = 132). All participants met the inclusion criteria for depression, which were defined by The Geriatric Depression Scale (GDS-15). From March to May of 2013, participants in the intervention group underwent a 2-month mutual recovery program intervention. The intervention included seven 90-min, weekly sessions that were based on a standardized self-designed schedule. Depression was used as primary outcome at three measurement moments: baseline (T1), before intervention at 24 weeks (T2), and immediately after intervention at 32 weeks (T3). Well-being and sleep quality were used as the secondary outcomes, and were evaluated based on the WHO-5 Well-being Index (WHO-5) and the Self-administered Sleep Questionnaire (SSQ). Finally, a total of 225 participants who completed all the sessions and the three measurements entered the final analysis. Mixed-model repeated measures ANOVAs were performed to estimate the intervention effects.

Results: There was no significant difference in gender, marriage, age structure, post-work type, and education background between the intervention and control group at baseline. Multivariate ANOVAs showed that there was no significant difference within the groups in terms of sleep, well-being, and depression at baseline and before the intervention. Mixed-model repeated measures ANOVAs detected a group × time interaction on depression, sleep, and well-being and showed a favorable intervention effect within groups immediately after the intervention.

Conclusions: The mutual recovery program could be a creative and effective approach to improve mental health in older community-dwelling adults with depressive symptom.

Keywords: Depression; Elderly population; Intervention; Mental health; Well-being.

Fig. 1

Flowchart of participant’ progress through the trial. The figure shows the study design and procedure. N is the number of communities, and n is the number of residents in the selected communities. Six communities were randomly selected from 24 communities in Pudong District, Shanghai. A depression screening was conducted in 1390 residents at baseline (T1). The intervention group and the wait-list control group were randomized based on the community. The intervention was conducted in the following 2 months after the screening, and 237 individuals participated in the final intervention program, including 105 participants in the intervention group and 132 in the control group. A total of 225 residents completed all the intervention sessions and follow-up survey and entered in the final analysis. The numbers that were lost to follow-up are also shown. Other reasons for loss to follow-up included a lack of time, a lack of confidence in the program, and taking care of a baby

Fig. 2

Score changes of Self-administered Insomnia Questionnaire, WHO-5 and GDS-15 on T1, T2, and T3. The figure illustrates the intervention effects on sleep quality, well-being, and depressive symptom. The sample size was 225. See Table 3 for statistical details