Optimizing Veterans’ Social Relationships to Enhance Depression Care

Award Type: Career Development Award
Funding Agency: VA Health Services Research and Development (VA HSR&D)
Role on Project: Principal Investigator

People with robust social relationships have better health outcomes, and close relationships may be especially critical in mental health care. Among those with depression, having close relationships and involving them in their treatment is associated with higher patient satisfaction and sustained remission. Further, social support is consistently found to be a protective factor against suicide. However, there are gaps related to involving close relationships in depression care.

Objective
To guide development of health services interventions that identify, engage, and harness the influences of Veterans' close relationships into their depression care in order to improve treatment response and reduce suicide behavior risk.

Methods
Briefly, a 12-month prospective cohort study of 200 VA primary care patients with major depression will be conducted to identify to what extent three social processes (social support, interpersonal conflict, and social norms) are associated with medication adherence, treatment engagement, help-seeking, patient activation and self-efficacy, self-management, suicidal ideation and behaviors, and depression severity (Aim 1). A subset of the cohort, individuals the patients identify as close relations in their social network, and VA clinicians, will participate in qualitative interviews and focus groups (Aim 2). These data will be used to explore the utility of close relationships in depression care and stakeholder preferences around potential interventions. Finally, a non-controlled intervention trial informed by findings of Aim 1 and Aim 2 will be conducted at the VA Portland Health Care System (Aim 3). Possible approaches include: active participation of close relationships in depression visits, symptom monitoring and adherence reporting; increasing social engagement with close relationships; and modifying maladaptive beliefs about depression held by Veterans' close relationships. Delivery will integrate with primary care-mental health initiative team activities. Evaluation will focus on acceptability and feasibility, with preliminary intervention efficacy. The expected outcome of this project will be preliminary data to guide development of a proposal for a larger randomized controlled trial of an intervention designed to be implemented in VA primary care settings.

Impact
Major depression is a top health services priority because of its high prevalence, large impact on quality of life, and association with suicide. Tapping the benefits of Veterans' close relationships and optimizing their involvement in depression care is a promising strategy to address upstream risk factors for suicide. Our approach will also capitalize on and enhance health services models integrating mental health treatment with primary care.

For findings, presentations and publications resulting from this project, please visit the study VA HSR&D page.