Table 2 Intervention Component, Content, and Modification for Target Population

Education [14, 25]

Education provides foundation for introducing other elements of the intervention. It enhances readiness of individuals to address emotion-laden concerns. Specifically, education was provided on: 1) depressive symptoms, 2) how to talk to doctor about symptoms; and 3) relationship of depression to activity and negative cycle of disengagement

1) Used participant's words and own labeling to describe feelings (e.g., "I am feeling blue").

2) With rapport and only over time, feelings are then labeled as symptoms of "depression."

3) Discussed how to talk to a doctor of a different race.

4) Withdrawal of activity related to specific activities person identified as valued.

5) Used visual mood rating scales and calendars with big print to minimize vision and literacy challenges.

Care management [12, 14]

Care management has been found to be more effective than therapy or medication alone for low income elders for whom financial, functional disability and lack of social resources may contribute to depressive symptoms. Specifically this involved: 1) assessment 2) coordination with other services/care management; 3) problem identification and resolution

1) Considered a wide range of care needs most relevant to this population including home repairs, financial concerns, home and neighborhood safety, family conflict.

2) Housing and neighborhood difficulties were evaluated to determine whether person could remain in setting.

Referral and linkage

[14, 25]

Referrals and linkages are derived from the care management assessment and may include: 1) physician referral for medication review and management; 2) link to psychiatric/psychological follow-up; 3) link to physician for chronic disease management; 4) referral and linkage to other services (e.g., home repairs, financial or legal advisors)

1) Referrals made to vetted community-based service providers sensitive to participants' resources and cultural preferences.

2) For individuals identified as in need of more mental health support, helped make bridge to these services

Stress reduction

Provides immediate, easy-to-learn technique to reduce stress of person and introduce relationship of action and mood change. Specific techniques included: 1) deep breathing; 2) counting; 3) use of music of personal interest

1) Recognition of importance of spirituality and possible objection to meditation as a stress reduction activity.

2) Use of relaxation CD/Tape with participants who did not want to participate in deep breathing exercise.

Behavioral Activation [14, 16, 25]

Approach is designed to increase frequency of pleasant events and provide positive reinforcement. Self-identification of goals/action plan promotes activation. The approach involves: 1) identification of valued activities and goals; 2) establishment of plan of action for goal attainment; 3) monitoring and adjustment of plan/goals; and 4) identification of new goals and steps to attain them and reinforcement and validation.

1) Awareness and identification of appropriate community-based programs and services that could help participants link to meaningful activities.

2) Use of "Pro/Con" lists and motivational interviewing in formulation of feasible goals.

3) Link individual to senior center to enable continuation of activity participation in a planful, structured setting.