(PS10-1) A Longitudinal Analysis of Coping Skills Across the Duration and 12-month Follow up of a Paraprofessional-delivered Depression Intervention for Older Adults

Coping skills are an important part of adjusting to age-related changes. Older adults experience unique physical, mental, and cognitive challenges that can exacerbate or precipitate mental health issues. Despite reports that approximately 30% of older adults experience depression at one time, mental health care utilization remains quite low in this population, with estimates of between 8-20% of older adults with mental illnesses receiving care (Unützer, 2002; Young et al., 2001; Zenebe et al., 2021). Therefore, understanding how older adults cope and in what ways mental health interventions can supplement existing coping skills is crucial in sustaining the health of older adults. Utilizing paraprofessionals who identify with and relate to communities of ethnically minoritized and low-income persons is a unique way of engaging such populations in mental health care while facilitating openness and reducing stigma. The PEERS intervention is a randomized controlled trial in which we randomized ethnically minoritized and low-income older adults to either: a peer support intervention (PEERS) or active control characterized by social interaction. Participants randomized to PEERS met with a paraprofessional who was trained by study staff to deliver depression care through: A) relationship building and person-centered communication; B) goal setting, sharing of experiential knowledge, modeling, and encouragement of attitudinal and behavioral change around depression self-care and coping, and C) linkage to community and clinical resources. The objective of this analysis is to compare improvements in depression and coping between a paraprofessional-delivered depression intervention and control.

We enrolled 149 participants in our depression care intervention for older adults. 134 completed their baseline assessment and will be included in the analysis. We assessed coping using the BRIEF Cope questionnaire and depression with the PHQ-9. A factor analysis of the baseline responses (N = 134) to BRIEF Cope revealed 7 groupings, which we will use to conduct a longitudinal analysis of depression scores across baseline, post-study, 3, 6, 9, and 12 month follow up, with coping factors as mediators, and compare coping between those who were assigned to PEERS (N = 69) and those to control (N = 65).

A factor analysis of the BRIEF Cope questionnaire revealed 7 significant factors using a factor loading cutoff of 0.5 for N = 134: 1) Cognitive Reframing, 2) Interpersonal Support, 3) Self-criticism, 4) Substance Use, 5) Humor, 6) Spirituality, and 7) Giving Up. A reliability analysis using Cronbach’s alpha for each factor demonstrated good reliability (0.9 > α ≥ 0.8) for factors 1, 2, 4, 5, 6, acceptable reliability (0.8 > α ≥ 0.7) for factor 3, and questionable reliability (0.7 > α ≥ 0.6) for factor 7. We will finalize and present longitudinal analysis results at a later time. Prior analyses with a different grouping of the BRIEF Cope items showed that depression scores improved for both PEERS and control groups, however mediators of depression differed between groups. Adaptive coping explained approximately 20% of the time effect on depression for the PEERS group across follow-up, but only explained at most 5% for the control group across follow-up.