Approximately a third of stroke survivors develop depression, and up to 60% experience some level of depressive symptoms. If left untreated, subthreshold depression often progresses to post-stroke depression (PSD), J. Beauchamp (overall Study PI at the Cizik School of Nursing at UT Health, Houston) said. Patients with PSD are at heightened risk for subsequent strokes, neurological deficits, diminished functioning, poor quality of life, and premature death from all causes including suicide. Behavioral activation (BA) focuses on identifying behaviors that positively affect mood. Patients are supported to engage in value-based activities as a depression prevention/treatment intervention. BA is a core component of cognitive behavioral therapy but can be delivered independently by lay counselors who are not licensed therapists. In this study, community health workers who are trained as lay counselors will deliver a BA via remote, video-enabled sessions with survivors within three months of their first stroke. About 300 low-income patients aged 55 and older will be recruited from the Stroke Transitions Education and Prevention Program in the Department of Neurology at McGovern Medical School at UTHealth Houston. They will participate in a randomized, controlled trial with half receiving BA and the other half receiving usual care. The intervention will include five weekly tele-delivered (video-conferenced) sessions and homework assignments with a series of follow-up calls and assessments for an additional nine months. The study aims to assess the effectiveness of the Tele-BA intervention in reducing depressive symptoms, anxiety, emotional distress, the proportion of stroke survivors who develop PSD, and the number of health care visits among participants.
As project Co-Investigator and Principal Investigator of The University of Texas at Austin, Dr. Namkee G. Choi will: 1) provide comprehensive advice for the PD/PI and other Co-Is and research team members on depression in late life, Tele-BA intervention implementation; 2) contribute to BA training for the research team; and 3) provide consultation on participants with worsening depressive symptoms and/or suicidal ideation. Additionally, Dr. Choi will collaborate with the PD/PI and other Co-Is and research team members in: 1) publishing outcome papers and in disseminating the outcomes in other ways; and 2) with positive outcomes, planning for the next steps for scaling BA for older adults who experienced stroke at the national level. She will communicate weekly or as needed in Years 1 and 4 and bimonthly Year 5, with Dr. Beauchamp and other team members via telephone, videoconferencing, or email.