Integrated Intervention for Depression and Asthma Self-management in Older Adults

Depressive disorders (DD) are highly prevalent among older adults with asthma and are associated with increased asthma morbidity. Asthma affects 8% of the United States population ≥ 60 years and older adults are more likely to die from asthma and have hospitalizations. Self-management behaviors (SMB) are key for achieving good asthma control. Unfortunately, depression is a major contributor to low adherence to controller medications and other SMB. We developed Supporting Asthma Self-Management Behaviors in Older Adults (SAMBA), a self-management support (SMS) program that improves asthma outcomes. However, it was not designed for patients with DD and secondary analyses showed SAMBA was less effective in these patients. Cognitive behavioral therapy for adherence and depression (CBT-AD) was designed for patients with chronic disease and depression and improves SMB, disease control, and depression. This proposal brings together a multidisciplinary team of investigators to test the feasibility and preliminary efficacy of an integrated intervention of SAMBA and CBT-AD. The Specific Aims are to: 1) Develop an integrated 10-12 session asthma SMS program with CBT-AD for older adults with uncontrolled asthma and comorbid DD (current major depressive disorder or persistent depressive disorder) with input from patients, caregivers and other stakeholders to validate content and protocols; 2) Conduct a pilot RCT to determine the feasibility and preliminary impact on asthma (medication use tracked by electronic devices, asthma control, quality of life, and lung function) and depression (Geriatric Depression Scale scores) outcomes of the SAMBA-CBT-AD intervention compared with SAMBA alone for urban older adults with uncontrolled asthma and a current DD. An exploratory aim will assess the mechanisms (via health beliefs and asthma management self-efficacy) underlying the effect of the integrated SAMBA-CBT-AD intervention. The pilot RCT will enroll 60 older adults (≥60 years) from practices in East Harlem, New York City. Participants will undergo a baseline evaluation of their asthma and the gold standard psychiatric interview to assess DD. Outcome measures will be assessed at intervention completion (month 3), and for sustainability at 6 months. This innovative theory-based intervention addresses a significant public health problem among older patients, who are rarely the focus of interventions, to improve both depression and asthma outcomes. The project will prepare the team for conducting a subsequent larger efficacy trial of the integrated SAMBA-CBT-AD intervention.