Building interdisciplinary/intersectoral research partnerships for community-based mental health research with older minority adults

Why Gerontology Needs Anthropology: Toward an Applied Anthropological Gerontology

In this essay, we argue that gerontologists should increase their engagement with anthropologists to increase transdisciplinary collaboration, fulfill the interdisciplinary promise of gerontology as a field, and to ensure the work of anthropologists is formed by, and employed in, situations where meaningful engagement with practitioners and policymakers can lead to social change. Anthropology is the study of human societies in historical, biological, and sociocultural context, comprising a holistic field of study that can contribute unique methods, approaches, and theories to the field of gerontology. Although increasing amounts of anthropological scholarship have focused on older adulthood, this critical work of anthropologists still needs to be utilized by those in positions of power to enact change. Furthermore, the work conducted by anthropologists of aging has not consistently been recognized as anthropological scholarship. Therefore, a notable gap exists between the promise of the anthropology of aging and the utilization of the field, its findings, and engagement with the broader gerontological academy. As such, the contributions of anthropology to aging scholarship and the resulting reduction in inequities in the aging experience are not always adequately recognized. By examining the history of anthropology's engagement with aging and the lifecourse, we argue for a more applied anthropological gerontology. We conclude with a call to action to ensure that anthropological gerontology is seen as a fundamental branch of scholarship, both within anthropology and gerontology, which can be used to improve the lived experiences of older adults globally.

Research-Practice Partnership to Develop and Implement Routine Mental Health Symptom Tracking Tool Among Older Adults During COVID-19

OBJECTIVE

Older adults are disproportionally impacted by the COVID-19 pandemic, causing a mental health crisis in late life, due to physical restrictions (e.g., quarantine), limited access to services, and lower literacy and access to technology. Despite established benefits, systematic screening of mental health needs of older adults in community and routine care settings is limited and presents multiple challenges. Cross-disciplinary collaborations are essential for identification and evaluation of mental health needs and service delivery.

METHODS

Using a research-practice partnership model, we developed and implemented a routine mental health needs identification and tracking tool at a community-based social services organization. Repeated screenings were conducted remotely over 5 months and included depression, anxiety, perceived loneliness, social support, and related domains such as sleep quality, resilience, and trauma symptoms linked to COVID-19. We examined symptomatic distress levels and associations between different domains of functioning.

RESULTS

Our project describes the process of establishing a research-practice partnership during the COVID-19 pandemic. We collected 292 screenings from 124 individuals; clients were mildly to moderately depressed and anxious, reporting large amounts of time alone and moderate levels of loneliness. Those reporting higher depressive symptoms reported higher anxiety symptoms, poorer sleep quality, lower quality of life, lower capacity to adapt to challenging situations, and greater trauma symptoms due to COVID-19.

CONCLUSION

Our routine screening tool can serve as a blueprint for case management agencies and senior centers nationwide, beyond the pressing mental health crisis due to COVID-19, to continue identifying needs as they emerge in the community.

Identifying actions to foster cross-disciplinary global health research: a mixed-methods qualitative case study of the IMPALA programme on lung health and tuberculosis in Africa

OBJECTIVES

To identify actions for fostering cross-disciplinary research (CDR) skills and collaborations in global health, and to produce recommendations for improving the design, implementation and management of cross-disciplinary global health research programmes.

DESIGN

Using a North-South global health research programme as a case study-and following an adapted framework-we conducted qualitative research using document reviews, semi-structured interviews (purposive sampling) and participatory observation. We used baseline survey findings to identify potential interviewees and tailor interview guides.

SETTING

Our case study was a 4.5-year (2017-2021) programme, namely, the International Multidisciplinary Programme to Address Lung Health and Tuberculosis in Africa (IMPALA). Led by a UK research institute, IMPALA spanned 22 partner organisations from 13 countries (10 in sub-Saharan Africa), and involved five research discipline groups: clinical science, social science, health systems, health economics and policy/research capacity.

PARTICIPANTS

Thirty-one IMPALA members were interviewed (July 2018-November 2019), with interviewees evenly split by gender (16 female and 15 male) and by Global North/South institution (15 non-African and 16 African). Twenty-five (81%) were researchers, comprising 18 senior researchers (professors, readers, associate professors and senior lecturers) and seven early career researchers (assistant professors, lecturers, research fellows, postdocs, research assistants and PhD students). Twenty-four programme events were observed (September 2018-April 2020) and 49 documents were reviewed (December 2017-April 2020). All 66 IMPALA staff were sent the baseline survey, receiving 51 responses (43/56 researchers and 8/10 non-researchers).

RESULTS

Fourteen themes emerged, which suggested that CDR-while valued by many-is not universally understood, and the time it requires is often underestimated. We found that fostering CDR and managing tensions needs planning and continuous discussions and interactions. A shared vision with explicitly agreed goals and roles and active management of cross-disciplinary activities is essential.

CONCLUSIONS

Active planning, implementation and management of cross-disciplinary activities are essential for the success of cross-disciplinary global health research and should be separate from the primary research activities.

Engaging in Late-Life Mental Health Research: a Narrative Review of Challenges to Participation

Purpose of review

This narrative review seeks to ascertain the challenges older patients face with participation in mental health clinical research studies and suggests creative strategies to minimize these obstacles.

Recent findings

Challenges to older adults’ engagement in mental health research include practical, institutional, and collaboration-related barriers applicable to all clinical trials as well as more personal, cultural, and age-related patient barriers specific to geriatric mental health research. Universal research challenges include (1) institutional barriers of lack of funding and researchers, inter-researcher conflict, and sampling bias; (2) collaboration-related barriers involving miscommunication and clinician concerns; and (3) practical patient barriers such as scheduling issues, financial constraints, and transportation difficulties. Challenges unique to geriatric mental health research include (1) personal barriers such as no perceived need for treatment, prior negative experience, and mistrust of mental health research; (2) cultural barriers involving stigma and lack of bilingual or culturally matched staff; and (3) chronic medical issues and concerns about capacity.

Summary

Proposed solutions to these barriers include increased programmatic focus on and funding of geriatric psychiatry research grants, meeting with clinical staff to clarify study protocols and eligibility criteria, and offering transportation for participants. To minimize stigma and mistrust of psychiatric research, studies should devise community outreach efforts, employ culturally competent bilingual staff, and provide patient and family education about the study and general information about promoting mental health.

A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research

OBJECTIVES

We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research.

METHODS AND RESULTS

We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs.

FINDINGS

Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports.

RECOMMENDATIONS

To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.

Comparisons of CES-D depression scoring methods in two older adults ethnic groups. The emergence of an ethnic-specific brief three-item CES-D scale

OBJECTIVE

To compare the reliabilities and convergent validities of five CES-D (Center for Epidemiologic Studies Depression) composite scores in two ethnic/racial groups of community-dwelling older adults.

DESIGN

CES-D measurement equivalence was tested with Structural Equation Modeling in Puerto-Rican (PR) and African American (AA) older adults, then reliabilities of five composite scores and their convergent validities were compared.

FINDINGS

Bayesian CES-D scores had the highest reliabilities, followed by software estimated factor scores, the unit weight, and the weighted scores. Bayesian CES-D scores, factor scores, and surprisingly a group-specific three-item brief CES-D score exhibited better convergent validity than the unit-weight and weighted CES-D scores.

CONCLUSIONS

An ethnic group-specific three-item brief CES-D score emerged as a reliable CES-D measure in PR and AA older adults. We conclude that practitioners could emphasize three main symptoms in individual older adults in screening for depression, and researchers can model with confidence the relationships between the CES-D brief scale and its correlates.

Understanding interdisciplinary collaborations as social networks

The dynamics of interdisciplinary collaboration invite further investigation if we are to make this endeavour more rewarding and productive. We are using social network analysis to track the development of a new interdisciplinary collaboration on complex interventions to improve population health. It involves nineteen scholars across four countries. We report the Baseline network of formal relationships among the scholars, along with the impact of the collaboration on these relationships in the first 18 months. We observed statistically significant increases in the density of six types of relationship networks: citing publications by other members of the collaboration, email contact, meeting with each other (outside of the formal annual meeting), visiting one another's institution, submitting research grants together and working on research projects together. The initial strategic role in the network of key 'gate keepers' has not altered substantially (betweenness centralization of the networks), but reciprocity has increased, that is, people are more likely to cite those who have cited them and work together. Increased collaboration is also reflected in the rise in number of subgroups over time and the increase in the average number of subgroup memberships. Use of social network analysis to understand the dynamics of interdisciplinary collaborations is a relatively new field. It invites reflection about what the optimal network structures for interdisciplinary collaborations would look like.

Overcoming barriers to conducting an intervention study of depression in an older African American population

The purpose of this article is to describe barriers and strengths of a study testing the effects of reminiscence on depressive symptoms in community-dwelling older African Americans. Primary data sources included debriefing sessions, reflective journals, participant observations, and key informant interviews. Data were analyzed using immersion/crystallization technique. Mistrust between gatekeepers and universities, recruitment and retention of research assistants and participants, culturally insensitive instruments, and stigma associated with depression were barriers. Successful approaches used to overcome the barriers experienced by the research team are described. Implications for transcultural nursing research and practice are discussed.

Mental health in senior housing: racial/ethnic patterns and correlates of major depressive disorder

OBJECTIVES

Mental health problems are associated with disability, overuse of medical care, higher rates of mortality and suicide as well as personal suffering for older adults. Residents of urban, low-income senior housing may face increased risk of a variety of mental health problems, including depression. This study identified the prevalence of multiple mental health problems in older residents of low-income senior housing and explored correlates of major depressive disorder for the two largest ethnic groups: black and Latino.

METHOD

In-person diagnostic interviews identified rates of mental illness in a sample of 635 residents of 13 low-income senior housing buildings in a medium-sized northeastern city. Applying George's Social Antecedent Model of Depression, logistic regression analyses identified shared and unique correlates of depression for Latino and black participants.

RESULTS

This population had high rates of major depressive disorder (26%), generalized anxiety disorder (12%) and other mental health problems that varied significantly by ethnic and racial group. Separate multivariate models for Latino and black people showed that younger age, more chronic conditions and social distress were related to major depressive disorder for both ethnic groups. Perceived environmental stress, shorter tenure in the building, poorer perceived health, higher life stress and fewer leisure activities were associated with depression for Latinos only.

CONCLUSION

Mental health screening and treatment services are needed in senior housing to address these high rates of mental illness. Unique constellations of correlates of depression for different ethnic groups underscore a need for culturally competent approaches to identification and treatment.

Cognitive Behavioral Intervention for Trauma in Schools (CBITS): school-based treatment on a rural American Indian reservation

This study examines a pilot school-based treatment program for American Indian adolescents residing on a reservation who presented with symptoms of Posttraumatic Stress Disorder (PTSD) and symptoms of depression. This is the first study directed at treating American Indian children with trauma; seven case studies demonstrate our findings that a manualized cognitive behavior therapy intervention delivered in group format for 10 weeks has potential for helping some children who experience PTSD symptoms and depression. The findings generally replicate previous research conducted with groups of non-Indian adolescents in urban settings. PTSD and depressive symptoms decreased for three of the four students who completed treatment. Directions for future research include the need to understand and control attrition and to address cultural influences, including making adaptations in the cognitive behavioral formulations and techniques regarding feelings as operant behaviors. Results contribute to knowledge of feasibility and acceptability of cultural adaptations of CBT for trauma in an under-served population.