Promoting the mental health of elderly African Americans: a case illustration

Improving health-related quality of life in older African American and non-Latino White patients

OBJECTIVE

To compare the effect of problem-solving therapy against a health-promotion intervention (dietary practices) on health-related quality of life (HRQOL) and examine if there is a differential effect on non-Latino white patients and African American patients between the two interventions. This paper also explores participant characteristics (problem-solving style and physical functioning) as potential predictors of HRQOL.

METHODS

Secondary analysis of data from a randomized depression prevention trial involving 247 older adults (154 non-Latino white, 90 African American, 3 Asian). Participants were randomly assigned to receive either problem solving therapy for primary care (PST-PC) or coaching in healthy dietary practices (DIET).

RESULTS

Both PST-PC and DIET improved HRQOL over two years and did not differ significantly from each other. African American patients in both conditions had greater improvements in mental health-related quality of life (MHRQOL) compared with non-Latino white patients. In addition, higher social problem-solving and physical functioning were predictive of improved MHRQOL.

CONCLUSION

PST-PC and DIET have the potential to improve health-related quality of life in a culturally relevant manner. Both hold promise as effective and potentially scalable interventions that could be generalized to highly disadvantaged populations in which little attention to HRQOL has been paid.

Recruitment of African Americans and Asian Americans with late-life depression and mild cognitive impairment

OBJECTIVE

The purpose of this study was to compare the relative effectiveness of several different strategies for recruiting elderly Asians, African Americans, and whites to participate in mental health research.

PARTICIPANTS

A total of 35 African American, 24 Asian American, and 215 white participants were phone screened for potential enrollment into a University of California, San Francisco, Department of Psychiatry treatment outcome study for older adults (aged 60 years and older) with major depression and mild cognitive impairment.

DESIGN

The methods by which participants were recruited were recorded, coded into composite categories, and statistically analyzed to determine whether certain recruitment strategies were disproportionately effective for recruiting participants from the three racial groups.

RESULTS

Fisher's exact test analyses revealed that Asians and African Americans were significantly less likely than whites to be recruited through mental health-based methods, and African Americans were significantly more likely than whites and Asians to be recruited through referrals rather than solicitations. Logistic regression, which controlled for potential confounds, largely supported these findings.

CONCLUSIONS

Findings suggest that the recruitment of elderly African or Asian Americans into mental health treatment outcome research can be facilitated by a flexible consumer-oriented strategy that integrates multiple recruitment methods. Establishing study credibility through nonmental health media and professional referral sources may be especially effective in engaging the participation of elderly Asian Americans; and cultivating ongoing relationships with key gatekeepers, who can observe benefits to the community, may be particularly effective in recruiting elderly African Americans.

Health promotion for aging adults

This article describes the essentials of health promotion, aging in America, and factors to consider when developing health promotion materials for elders. It also provides a checklist to evaluate materials for appropriateness.

Clinical ethics revisited: responses

This series of responses was commissioned to accompany the article by Singer et al , which can be found at . If you would like to comment on the article by Singer et al or any of the responses, please email us on editorial@biomedcentral.com .