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Feasibility of a cluster randomized controlled trial of a psychosocial intervention to improve late life depression in socioeconomically deprived areas of São Paulo, Brazil (PROACTIVE)

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  • Marcia Scazufca
  • Paula Pereda

Abstract

Background: Depression is a common and recurrent condition among older adults and is associated with poor quality of life and increased health care utilization and costs. The purpose of this study was to assess the feasibility of delivering a psychosocial intervention targeting depression, and to develop the procedures to conduct a cluster randomized controlled trial (RCT) among older adults registered with primary care clinics in poor neighbourhoods of São Paulo, Brazil. Methods: We conducted a pilot study of a two-arm cluster RCT using a protocol developed previously (see accompanying paper). Two primary care clinics adhering to the Family Health Strategy were allocated to either the intervention or the control arm. In the control arm, patients received enhanced usual care consisting of staff training for improved recognition and management of depression. In the intervention arm, alongside the enhanced usual care, patients received a 17-week psychosocial intervention delivered by health workers assisted with an application installed in a tablet. Results: We randomly selected 579 of 2020 older adults registered in the intervention clinic to participate in the study. Among these individuals, 353 were assessed for depression and 40 (11.0%) scored at least 10 on the PHQ-9 and were therefore invited to participate. The consent rate was 33/40 (82%) with a resulting yield of 33/579 (5.7%). In the control arm, we randomly selected 320 older adults among 1482 registered in the clinic, 223 were assessed for depression and 28 (12.6%) scored 10 or above on the PHQ-9. The consent rate was 25/28 (89%), with a resulting yield of 25/320 (7.8%). Of the 33 who consented in the intervention arm, 19 (59.4%) completed all sessions. The mean PHQ-9 at follow-up (approximately 30 weeks after inclusion) was 12.3 (SD=3.7) and 3.8 (SD=3.9) in the control and intervention arms respectively. Follow-up rates were 92% and 94% in control and intervention arms, respectively. Conclusions: Identification and engagement of clinics, random selection and recruitment of individuals, baseline and follow-up assessment all proved to be feasible in primary care clinics in São Paulo, Brazil. Results support the development of a definitive cluster RCT.

Suggested Citation

  • Marcia Scazufca & Paula Pereda, 2019. "Feasibility of a cluster randomized controlled trial of a psychosocial intervention to improve late life depression in socioeconomically deprived areas of São Paulo, Brazil (PROACTIVE)," Working Papers, Department of Economics 2019_22, University of São Paulo (FEA-USP).
    • Handle: RePEc:spa:wpaper:2019wpecon22
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    References listed on IDEAS

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    1. Grewal, Ini & Lewis, Jane & Flynn, Terry & Brown, Jackie & Bond, John & Coast, Joanna, 2006. "Developing attributes for a generic quality of life measure for older people: Preferences or capabilities?," Social Science & Medicine, Elsevier, vol. 62(8), pages 1891-1901, April.
    2. Beatriz Eugenia Alvarado & Maria Victoria Zunzunegui & François Béland & Maryline Sicotte & Lourdes Tellechea, 2007. "Social and Gender Inequalities in Depressive Symptoms Among Urban Older Adults of Latin America and the Caribbean," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 62(4), pages 226-236.
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    More about this item

    Keywords

    older adults; depression; pilot controlled trial; primary care; collaborative care intervention.;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I10 - Health, Education, and Welfare - - Health - - - General
    • C93 - Mathematical and Quantitative Methods - - Design of Experiments - - - Field Experiments
    • C90 - Mathematical and Quantitative Methods - - Design of Experiments - - - General

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