(PS3-1) A Profile of Victims’ Clinical Needs: Elder Abuse and the PROTECT Intervention

Intro: Elder abuse (EA) impacts 10% of older adults in the US and is associated with poor mental and physical health outcomes. Depression rates are high among EA victims, and depression among victims is linked to higher mortality rates. Despite the need for mental health services, few interventions are designed to specifically target depression concurrent with interventions to decrease victimization and promote safety. In collaboration with our partners at the Elder Justice Unit of NYC Department for the Aging, we designed a program to screen for depression (PHQ-9) and anxiety (GAD-7) and offer a brief behavioral therapy (PROTECT) alongside EA amelioration services to those who screen positive. PROTECT is a manualized 9-session therapy combining psychoeducation, behavioral activation, and goal setting to decrease depression and increase empowerment to reduce victimization.  

Aims/

Method: We examined the relation of demographic and EA characteristics and the rates of comorbid anxiety and post-traumatic stress disorder symptoms among depressed EA victims in NYC (n=80). Depression severity (MADRS) and PTSD (PCL-5) symptoms were measured prior to beginning PROTECT therapy.  

Results: Victims were predominantly black (55.0%) and female (82.5%); 13.8% were Hispanic/Latino. The most frequently reported abuse types were emotional/psychological abuse (82.5%), financial abuse (61.3%) and physical abuse (50.0%). Financial strain was prevalent: over half (53.8%) reported having “just enough to get along” and 65% lived at or below the poverty line. Previous MH treatment was reported by 49.4% of victims; 35.9% reported previous antidepressant use. Baseline MADRS scores (M=23.35, SD=6.62) indicated 73.8% displayed symptoms of moderate depression. Almost two-thirds (62.0%) met SCID criteria for major depression (MDD) and 28.7% met criteria for minor depression. Over half (60%) of EA victims met criteria for PTSD. No significant associations were found between depression severity, race, or economic stability. There was a significant positive correlation between depression severity and physical abuse, (rpb = .264, p = .019). Results found black victims as less likely to have received prior MH treatment X2 (1, N=79) = 15.61, p</span> < .001, and less likely to have used antidepressants X2 (1, N=79) = 18.63, p <.001). Black victims disproportionally reported emotional and psychological abuse, X2 (1, N = 79) = 6.71, p = .010. Victims with greater depressive symptoms endorsed more severe PTSD symptoms, r=.615, p< .001. 

Discussion: Elder abuse is prevalent, and victims have high rates of mental health need. The findings on race and prior treatment support current literature suggesting non-white depressed individuals as less likely to seek care; future interventions may target improving access to care among community-dwelling older adults who may face additional barriers to treatment. The prevalence of PTSD symptoms among EA victims suggests mistreatment can have lingering effects and may be associated with longer term health outcomes and increased depression severity. Future work will examine the impact of PTSD on response to treatment for depression among EA victims.  

Support: Weill Cornell ALACRITY P50MH113838-02 and NIMH R01MH132757