Peer-Supported Problem-Solving May Help Older Rural Adults With Depression

Older adults who completed 12 weeks of self-guided problem-solving therapy (PST) supported by trained peer volunteers had significant and lasting improvements in their depression scores, according to a report in Psychiatric Services in Advance. PST is a psychotherapy that teaches people to generate realistic solutions to life problems that contribute to depression.

“PST with a clinician should be considered a preferred treatment option when resources are available,” wrote Brooke Hollister, Ph.D., at the University of California, San Francisco, and colleagues. However, self-guided-PST supported by trained peer counselors “may be an appropriate and acceptable alternative to [clinician-managed]-PST (or other evidence-based interventions) for older adults who live in rural areas and experience barriers to access because of stigma, poor transportation options, or a lack of available clinicians and services.”

A total of 105 rural Californians aged 60 or older who had moderate to severe unipolar depression but did not have psychotic depression, a high suicide risk, or other major psychiatric disorders participated in the study. Eighty-five participants received clinician-managed PST with specially trained master’s level therapists or social workers, while the remaining 20 embarked on self-guided PST supported by peers who had also received special training. Both groups completed the PST sessions in their homes.

Depression levels were assessed with the Hamilton Depression Rating Scale [HAM-D]. Improvements in depression were clinically significant in both groups after 12 weeks, though clinician-managed PST did lead to higher response, remission, and retention rates, the researchers reported. Still, 45% of the adults in the peer-supported, self-guided group showed a treatment response of at least 50% reduction in HAM-D scores by week 12.

At 24 weeks, the groups equalized as the rates of depression reported by the self-guided group continued to drop, while the clinician-managed group’s depression scores rose slightly. This finding might imply a longer-lasting impact of self-guided treatment, given its focus on empowering patients to address their own problems, the researchers wrote. However, because the completion rate was lower for this group, Hollister and colleagues recommended further research to explore why.

“Effective use of [trained peer counselors] to support evidence-based treatments has the potential to maintain the independence of rural older adults by improving their access to mental health services and using existing infrastructure and minimal community resources,” they concluded.

For related information, see the Psychiatric Services article “Opportunities and Challenges to Build Behavioral Health Crisis Capacity in Rural America,” also published today.

(Image: Getty Images/iStock/KatarzynaBialasiewicz)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on X!

Follow Psychiatric News on LinkedIn!

Life Outlook Improves When Patients Work With Peers, Meta-Analysis Suggests

Patients with mental illness who receive services delivered by individuals with lived experience of mental illness (peer support services) may experience greater personal recovery (for example, life satisfaction and hopefulness) than those patients who do not receive peer support services, a meta-analysis in Psychiatric Services in Advance has found.

“The effect of peer support on personal recovery was most pronounced in peer support delivered as an add-on to mental health hospital treatment,” wrote Cecilie Høgh Egmose, M.Sc., of the University of Copenhagen in Denmark and colleagues. “However, the evidence for the efficacy of peer support provided independently of hospital settings and online is promising and requires more high-quality [randomized, controlled trials] and attention from policy makers and funders.”

Høgh Egmose and colleagues compiled data from 49 randomized, controlled trials testing the effectiveness of peer support interventions that were delivered by peers only or by both mental health professionals and peers. Peers included individuals in paid and volunteer positions.

The combined data included 12,477 patients with a range of conditions including schizophrenia, bipolar disorder, depression, anxiety, and eating disorders. The peer support programs were divided into four categories, including those led by as follows:

1. Peers working in hospital services (for example, recovery mentors delivered one-to-one peer support or group-based, peer-led self-management programs).
2. Peers working in nonhospital settings, such as a university research center or a residential program.
3. Peers working in established, paid service positions (for example, peers helped to facilitate conversations about requests for treatment, assertive community treatment, and occupational rehabilitation goals).
4. Peers working with online support groups.

Overall, peer support was associated with a small positive effect on personal recovery compared with control interventions such as placement on a waitlist or receipt of usual care. Peer support was also associated with a slight decrease in anxiety and seemed to have a positive impact on patients’ hope and self-advocacy.

“We found that peers employed and trained in supporting roles in the mental health hospital treatment service had a small positive effect on personal recovery, had a small-to-moderate positive effect on self-efficacy, and were associated with a small reduction in overall psychiatric symptoms,” Høgh Egmose and colleagues wrote. “Nevertheless, before we can recommend implementation of peer support in specific health care settings, co-created high quality trials measuring the effectiveness, including potential adverse effects, and the cost-effectiveness of the intervention are needed.”

To read more on this topic, see the Psychiatric News articles “Peer Support Specialists Can Play Important Role in Patients’ Lives” and “Peer Specialists Can Aid in Suicide Prevention.”

(Image: iStock/FatCamera)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

One 20-Minute Call May Encourage Medication Treatment, Lower Overdose Risk in Patients With OUD

Receiving a 20-minute phone call from a trained peer counselor may help prompt people who have overdosed on opioids to begin medication treatment and lower their risk of another opioid overdose, suggests a study in Drug and Alcohol Dependence.

Theresa Winhusen, Ph.D., of the University of Cincinnati College of Medicine and colleagues compared the rates of medication treatment enrollment, opioid overdose, and opioid use in 80 patients who were randomized to receive either standard education or education with a personalized call. Standard education consisted of an information packet with three reports that were generated from the patient’s responses to two surveys, the Personal Opioid-Overdose Risk Survey and the Opioid Overdose and Treatment Awareness Survey (OOTAS). Those in the intervention group received the standard education as well as the phone call. All patients received a naloxone nasal spray kit.

Peer counselors were enrolled in a medication treatment program for at least a year; had not used opioids for at least a year; and had experienced, witnessed, or lost a family member or friend to an overdose. They completed practice calls as part of their training, and they were required to score at least 90% on the OOTAS. All told, training and certification as a peer counselor took four hours. During the phone call with the patient, the peer counselor discussed medication treatment and answered the patient’s questions. The peer counselors were provided with guidelines for the calls, but the calls were not scripted.

At 12-month follow-up, 32.5% of patients who had received a call had begun medication treatment for opioid use disorder, compared with 17.5% of those who did not receive a call. Those who had received a call also had a lower rate of opioid overdose, 12.5% compared with 32.5% among those who had not received a call. However, there were no significant differences between opioid use between the groups, as shown by urine drug screenings conducted at different points throughout the 12 months.

“In the current era of COVID-19, it is notable that this intervention was designed to be implemented by phone, thus eliminating the need for in-person contact,” the researchers wrote. “[T]he results from this randomized pilot trial suggest that a brief, telephone-delivered intervention has promise for increasing [medication for opioid use disorder] enrollment and decreasing recurring opioid overdoses in individuals surviving an opioid overdose. Further development and testing of this … intervention, particularly in light of the current U.S. opioid epidemic, seems warranted.”

For related information, see the Psychiatric News article “SAMHSA Issues Guidance on OUD Treatment During COVID-19.”

(Image: iStock/martin-dm)