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Houston, Texas

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Depression Self-Management for Rural Women with Disabilities

Rosemary B. Hughes, PhD, Principal Investigator

Funded by the National Institute on Disability and Rehabilitation Research

Project Update

Depression and Rural Women with Disabilities:
Testing a CIL-based Self-Management Program

Rural women with disabilities constitute a high-risk group for depression. This population of women faces substantial barriers to independent living including poverty, social isolation, limited transportation, unaffordable housing, limited access to employment, and lack of access to health care providers who are knowledgeable about disability. Rural women may be at elevated risk for depression as a result of having a disability, being female, and living in a rural setting.

To the best of our knowledge, no program has been designed and evaluated to address the unique mental health needs of this large population of women. Our aim with this project is to contribute to closing that gap with the far-reaching goal of providing an effective program that someday could be implemented in every rural center for independent living (CIL) throughout the nation.

The purpose of this project is to develop and evaluate a depression self-management group intervention designed to reduce depression in rural women with disabilities. Our weekly, 8-session intervention is designed to increase participants' understanding of depression and their self-efficacy for and skills in the self-management of depressive symptoms. The depression group intervention includes various activities and strategies for learning to self-manage depression, increase one's self-efficacy, and enhance social connectedness and support. Our primary outcome is level of depression.

The first year of the project involved the curriculum development; consultations with consumers, advisors, and consultants; design, development, and production of the participants' and leaders' manuals, and the training program handbook; and, the development and completion of the facilitator training program. The program involves a disability-sensitive and gender-specific adaptation of Dr. Lynn Rehm's Depression Self-Management Therapy program that has been widely tested in the general population including veterans. Dr. Rehm is one of the consultants on the project.

The leaders' manual for the intervention program contains a carefully scripted presentation for each of the 8 sessions to assure that all groups receive the same information. Last year, the directors of the participating CILs identified two women with disabilities (one CIL staff member with a disability and another woman with a physical disability) to serve as co-leaders for the intervention. One co-leader from each site completed an intensive facilitator training program provided by CROWD staff and peer leaders in Houston. During the 8 weeks of their weekly, 2 ½ group intervention program, the CIL leaders participate in required weekly individual supervision sessions with the clinical psychologist whose primary objective is to assure risk management. The leaders also have ready email and telephone access to the principal investigator and the project director (both psychologists). Additionally, the project retains a licensed counselor in the immediate locale of each of the centers. The leaders have ample opportunity to consult with one another via routine meetings with the CROWD project staff or via email. The project has a dedicated list serve.

The pilot study for this project was held at the Houston Center for Independent Living satellite office in Brazoria County. The process for selecting CILs from across the country to participate in the full implementation of this research study involved the directors responding to letters and email announcements advertising (e.g., with the assistance of the Association of Programs for Rural Independent Living) the opportunity to participate in a research study. Directors or their designees from 30 CILs expressed interest and subsequently completed highly structured interviews with CROWD project staff. Their responses were rated, and ten CILs were selected to participate. States represented by these centers are Arizona, Florida, Indiana, Arkansas, Kansas, Colorado, New Mexico, Maine, Wisconsin, and Wisconsin. As of May 2005, the intervention program had been implemented in nine of the original CILs. The informal feedback from the leaders has been highly positive. In describing her experience in facilitating the first session with her group, one leader referred it one of the "best days of her [my] life". The CIL facilitators and their directors are highly committed to the success of this project.

As soon as we have completed the group program in each of the CILs, we will have more information on this exciting and important research project. The project is funded by the National Institute on Disability and Rehabilitation Research (NIDRR). For additional information, please contact us by clicking Contact CROWD below, and ask for Dr. Rosemary Hughes, Principal Investigator, or Kathy Fire, Project Coordinator.

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