A low-intensity behavioral intervention for depression in older adults delivered by lay coaches: proof-of-concept trial

Abstract

Objectives

A broader workforce is necessary to expand U.S. geriatric mental health services. We examined (1) feasibility of training undergraduate students to deliver Do More, Feel Better (DMFB), an evidence-informed program for depression; and (2) feasibility, acceptability, and outcomes in a single-arm proof-of-concept trial.

Method

In Study 1, we taught DMFB to 18 upper-level undergraduate students and assessed fidelity using role plays. In Study 2, four students delivered six weekly DMFB sessions to 12 community-dwelling older adults (M = 66.83 years old, SD = 10.39) with depression (PHQ ≥ 10). Patient outcomes were change in pre- to post-treatment depressive symptoms, disability, and the target mechanism of increased activity.

Results

Fidelity was high in the course (Study 1; 82.4% of role plays rated as ‘passing’) and the trial (Study 2; 100% of 24 sessions rated as ‘passing’). The majority (83.3%) of patients were retained and evidenced statistically and clinically significant improvement in depressive symptoms (Hamilton Rating Scale for Depression [HAM-D]), disability (World Health Organization’s Disability Assessment Schedule 2.0 [WHODAS 2.0], and activity (Behavioral Activation for Depression Scale [BADS]).

Conclusion

It is feasible to train bachelor’s-level students to deliver a brief, structured intervention for depression. Future research should consider implementation strategies and stakeholder feedback.

Keywords:

• Task sharing
• task shifting
• lay counselor
• behavioral health
• late-life depression
• tele-health
• mental health services

Acknowledgements

Portions of this work were previously presented at the Association for Behavioral and Cognitive Therapies (ABCT) 54th Annual Convention, held virtually from November 17–22, 2020. We thank Kelly Thompson, Leah Lucid, and Noah Triplett for their instrumental support as teaching assistants for courses conducted at the University of Washington. We thank our student coaches for their dedication to this project and to the well-being of their patient participants.

Funding

This publication was supported in part by the National Institute of Mental Health (grants P50MH115837, T32MH073553, and R34MH111849), the Integrated Care Training Program at the University of Washington, and intramural funding through the Population Health Initiative at the University of Washington.

Disclosure statement

The authors have no completing interests to declare.

Data sharing statement

The data that support the findings of this study are available on request from the corresponding author.