Testiranje efektivnosti programa psihosocijalne podrđke starijim osobama: kvazi-ekspeerimetalna studija

Abstract

NVO PIN je sprovela proces mapiranja najprioritetnijih potreba i najistaknutijih nedostataka u pružanju usluga mentalnog zdravlja u petnaest gradova u Srbiji. U tom procesu, usluge koje imaju za cilj unapređenje mentalnog zdravlja starijih osoba su istaknute kao jedan od glavnih prioriteta u lokalnim zajednicama. Tako je NVO PIN odgovorila na ove potrebe kroz implementaciju i testiranje Programa psihosocijalne podrške starijim osobama tokom šest meseci u dva grada u Srbiji koja su označena kao prioritetna (Šid i Sremska Mitrovica). Program je bio mešovitog tipa, sastojao se od individualnih sesija i grupnih radionica koje su mogle da se pohađaju i odvojeno i paralelno, a održavali su ih psiholozi koji su prošli jednodnevnu dodatnu obuku o implementaciji Programa. Uopšteno govoreći, teme obuhvaćene Programom bile su: usamljenost, depresija, anksioznost, nada, odnosi sa drugima, borba protiv starenja i stigme, nada i asertivna komunikacija. Sesije su bile i psihoedukativne i terapijske. Nije bilo ograničenja za pristupanje Programu, osim starosne granice preko 55 godina. Korišćen je kvazi-eksperimentalni dizajn. Kriterijumi za uključivanje u istraživanje bili su uzrast stariji od 55 godina i odsustvo drugog oblika psihosocijalne podrške. Ukupno 33 starije osobe (Mgod=74.18, SDgod=10.13, 27% muškaraca) izrazilo je interesovanje da se pridruži Programu i na taj način raspoređeno u eksperimentalnu grupu, dok 21 osoba (Mgod =72.86, SDgod =10.31, 43% muškaraca) nije izrazila interesovanje da se pridruži Programu pa su ove osobe stoga raspoređene u kontrolnu grupu. Bilo je 1-9 individualnih i 2-10 grupnih sesija po korisniku iz eksperimentalne grupe. Svaki učesnik je popunio inventare koji su merili subjektivno blagostanje (WHO5, 5 stavki; α = .88 - .90150), kvalitet života (MANSA, 12 stavki; α = .50 - .85), usamljenost (UCLA skala usamljenosti, 20 stavki); α = .82 - .88), depresiju (PHQ9, 9 stavki; α = .79 - .85) i anksioznost (GAD7, 7 stavki; α = .73 - .86) u tri vremenske tačke: pre početka Programa (pre-test), odmah nakon Programa (posttest) i mesec dana nakon završetka Programa (naknadno merenje). Rezultati su pokazali da je čak i nakon kontrole rezultata sa pre-testa, došlo do značajnog poboljšanja u eksperimentalnoj grupi na post-test merama blagostanja (F(1)=40.358, p<.001, ηp 2=.45), usamljenosti (F(1)=6.253, p<.05, ηp 2=.11), depresije (F(1)=16.534, p<.001, ηp 2=.25) i anksioznosti (F(1)=24.187, p<.001, ηp 2=.33), dok je došlo do marginalne pozitivne promene u kvalitetu života (F(1)=3.885, p=.055, ηp 2=.08). Štaviše, nakon kontrolisanja rezultata iz pre-testa, poboljšanje u eksperimentalnoj grupi je ostalo značajno na naknadnom merenju depresije tokom praćenja (F(1)=8.226, p<.01, ηp 2=.14). Ovi rezultati potvrđuju efektivnost Programa za psihosocijalnu podršku starijim osobama u poboljšanju mentalnog zdravlja starijih osoba i pružaju važne dodatne inpute za praksu zasnovanu na dokazima. Iako je pokazano da se može ostvariti dugotrajniji rezultat u slučaju poteškoća sa mentalnim zdravljem kao što je depresija, naglašava se potreba za kontinuiranom podrškom starijim osobama.

NGO PIN conducted the process of mapping the highest-priority needs and most prominent gaps in the provision of mental health services in fifteen cities in Serbia. In that process, services aimed at improving the mental health of older adults are highlighted as one of the top priorities in local communities. Thus, NGO PIN responded to these needs by implementing and testing the Program for Psychosocial support for older adults over the course of six months in two cities in Serbia that were marked as a priority (Šid and Sremska Mitrovica). The Program was mixed-type, consisting of individual sessions and group workshops, both accessible to all participants, and held by psychologists that underwent one-day additional training on Program implementation. Broadly, the topics covered within the Program were: loneliness, depression, anxiety, hope, relationships with others, combating ageism and stigma, hopefulness, and assertive communication. The sessions were both psychoeducational and therapeutic. There were no restrictions on joining the Program, except the age limit of over 55 years of age. A quasi-experimental design was used. Inclusion criteria for participating in the research were being over 55 years of age and not being subject to any other form of psychosocial support. A total of 33 older adults (Mage=74.18, SDage=10.13, 27% males) expressed an interest to join the Program and thus were assigned to the experimental group, while 21 individuals (Mage=72.86, SD=10.31, 43% males) haven’t expressed an interest to join the Program and thus were assigned to the control group. There were 1-9 individual and 2-10 group sessions per beneficiary from the experimental group. Each participant completed inventories measuring well-being (WHO5, 5 items; α = .88 - .90155), quality of life (MANSA, 12 items; α = .50 - .85), loneliness (UCLA Loneliness Scale, 20 items; α = .82 - .88), depression (PHQ9, 9 items; α = .79 - .85) and anxiety (GAD7, 7 items; α = .73 - .86) at three time points: before the Program started (pre-test), immediately after the Program (post-test) and one month after the Program has ended (follow-up). The results showed that even after controlling for the scores from the pre-test, there was a significant improvement in the experimental group on post-test measures of well-being (F(1)=40.358, p<.001, ηp 2=.45), loneliness (F(1)=6.253, p<.05, ηp 2=.11), depression (F(1)=16.534, p<.001, ηp 2=.25), and anxiety (F(1)=24.187, p<.001, ηp 2=.33), while there was a marginal positive change in the quality of life (F(1)=3.885, p=.055, ηp 2=.08). Moreover, after controlling for scores from the pre-test, the improvement in the experimental group remained significant on the follow-up measures of depression (F(1)=8.226, p<.01, ηp 2=.14). These results confirm the effectiveness of the Program for Psychosocial support for older adults in improving the mental health of older adults, and provide important further inputs for evidencebased practice. Even though it is shown that a longstanding impact can be made in the case of mental health difficulties such as depression, the need to provide continuous support to older adults is highlighted.