Improving engagement in mental health treatment for home meal recipients with depression

Figures & data

Figure 1 Recruitment for Open Door study.

Table 1 Examples of Open Door intervention

Psychologic barrier	Open Door intervention activity	Source of technique (PST, MI, or PE)	Outcome
Personal stigma concern: “My neighbor will not include me if she thinks I’m crazy.”	Validate concern (stigma is real!)	MI – reflective listening and empathy	Support
	Define disclosure options	PST – brainstorming	More hope
	Emphasize personal choice	MI – collaboration	Less helplessness
	Review pros and cons of each option	PST – identify pros and cons and compare	Action plan
Treatment efficacy concerns: “What’s talking going to do? Nothing can change.”	Identify hopeless as symptoms of depression	PE- – education about depression	Increase in knowledge
		PST – identify a goal	Increased motivation
	Identify what she wishes to change	PE – review psychotherapy efficacy data and discuss the process of seeking care	Engagement
	Link goal with treatment outcome
Attribution of depression symptoms: “It’s the diabetes and my age that cause my troubles”	Validate overlap of medical and psychologic symptoms	PE – depression symptom and medical symptom overlap	Increased knowledge
			Increased perceived need for treatment
	Describe symptoms of depression	PE – information on depression
	Review myths and potential for misattribution	PE – discuss myths and stereotypes

Abbreviations: PE, psychoeducation; PST, problem-solving therapy; MI, motivational interviewing.

Table 2 Sample characteristics (n = 137)

Demographic characteristics	Number or range	Percent/mean (SD)
Female	98	72%
Age, years	57–98	78 (9.3)
Hispanic origin	11	8%
Race
African American origin	42	31%
Caucasian	94	69%
Other	1	0.7%
Education, years	1–25	12.18 (3.7)
Marital status
Single	19	14%
Married	19	14%
Once married	99	72%
Live alone	89	65%
Clinical characteristics
Depression diagnosis
None	49	36%
Minor	18	13%
Major	70	51%
Endorsed suicidal ideation (%)	40	29%
Fall in previous 6 months	50	37%
Service utilization (previous 3 months)
Inpatient hospitalization	26	19%
Emergency room visit	22	16%
Number of medical conditions	0–14	6.1 (2.7)
Number of current medications	1–18	6.5 (3.3)
Number of IADL impairments	0–7	3.4 (2.0)

Abbreviations: IADL, instrumental activities of daily living; SD, standard deviation.