Flora Ma

All Publications

• Older Veterans' Treatment Preferences: Psychotherapy and Self-Management Treatment Modalities. Clinical gerontologist Ma, F., Carlson, C., Gomez, R., Gould, C. E. 2022: 1-11

  Abstract

  OBJECTIVES: Self-management may help older Veterans with mental health challenges and can overcome barriers to traditional psychotherapy. However, the reasons underlying older Veterans' treatment preferences remain unknown. The current study investigated older Veterans' perspectives on psychotherapy and self-management.METHODS: Seventy-four Veterans ≥ 60years old were included in this mixed methods study. Participants provided rationale(s) after ranking their preferences for psychotherapy and four self-management modalities. Logistic regressions examined whether depressive and anxiety symptom severity contributes to preferences. Qualitative analyses were conducted to investigate reasoning for preferences.RESULTS: Most participants preferred psychotherapy (64.9%) over self-management (35.1%). Logistic regressions showed that depressive and anxiety symptom severity was not significantly associated with preferences. Qualitative analyses revealed that past experience and access-related barriers were underlying the preferences. Themes unique to psychotherapy included the availability of emotional support and the process of information sharing. In contrast, ease of access was associated with self-management.CONCLUSIONS: Older Veterans preferred psychotherapy to receive support and to develop trust in meeting their goals.CLINICAL IMPLICATIONS: Older Veterans' needs point to the importance of providers' consideration of a person-centered approach and treatment collaboration. Notably, Veterans' preference for psychotherapy highlights the importance and need for human support in addition to self-management tools.

  View details for DOI 10.1080/07317115.2022.2079447

  View details for PubMedID 35616145

• Effects of Mobile App-Based Intervention for Depression in Middle-Aged and Older Adults: Mixed Methods Feasibility Study. JMIR formative research Gould, C. E., Carlson, C., Ma, F., Forman-Hoffman, V., Ranta, K., Kuhn, E. 2021; 5 (6): e25808

  Abstract

  BACKGROUND: Digital mental health interventions may help middle-aged and older adults with depression overcome barriers to accessing traditional care, but few studies have investigated their use in this population.OBJECTIVE: This pilot study examines the feasibility, acceptability, and potential efficacy of the Meru Health Program, an 8-week mobile app-delivered intervention.METHODS: A total of 20 community-dwelling middle-aged and older adults (age: mean 61.7 years, SD 11.3) with elevated depressive symptoms participated in a single-arm pilot study investigating the Meru Health Program, an app-delivered intervention supported by remote therapists. The program primarily uses mindfulness and cognitive behavioral skills to target depressive symptoms. A semistructured interview was completed at the baseline to establish current psychiatric diagnoses. Depressive symptoms were measured using the Patient Health Questionnaire and Patient-Reported Outcomes Measurement Information System (PROMIS) depression measures. Anxiety symptoms were measured using the Generalized Anxiety Disorder Scale and the PROMIS Anxiety measure. User experience and acceptability were examined through surveys and qualitative interviews.RESULTS: In total, 90% (18/20) of the participants completed the program, with 75% (15/20) completing at least 7 of the 8 introductory weekly lessons. On average, participants completed 60 minutes of practice and exchanged 5 messages with their therapists every week. The app was rated as helpful by 89% (17/19) participants. Significant decreases in depressive (P=.03) and anxiety symptom measures (P=.01) were found; 45% (9/20) of participants showed clinically significant improvement in either depressive symptoms or anxiety symptoms.CONCLUSIONS: The findings suggest that the commercially available Meru Health Program may be feasible, acceptable, and potentially beneficial to middle-aged and older adults. Although larger controlled trials are needed to demonstrate efficacy, these findings suggest that digital health interventions may benefit adults of all ages.

  View details for DOI 10.2196/25808

  View details for PubMedID 34185000

• Development and Refinement of Educational Materials to Help Older Veterans Use VA Mental Health Mobile Apps. Professional psychology, research and practice Gould, C. E., Loup, J., Scales, A. N., Juang, C., Carlson, C., Ma, F., Sakai, E. Y. 2020; 51 (4): 414-423

  Abstract

  The U.S. Department of Veterans Affairs (VA) in collaboration with the Department of Defense has created mobile applications (apps) that target military Veteran-specific mental health challenges. With over half of Veterans being older than 65, it is essential to support these individuals' access to and use of these apps. One critical barrier to older adults using apps is that they may not be aware of mental health apps and often need assistance learning to use their devices. To address these gaps in knowledge, we designed and evaluated patient education materials teaching how to download apps and the basics of mobile device use. The materials also included step-by-step guides for three VA mobile apps: Mindfulness Coach, Mood Coach, and PTSD Coach. Guided by user-centered design and feedback from providers and older Veterans, the materials were developed and refined. Six local technology and geriatric content experts provided initial feedback. Next, six older Veterans (M = 78.5 years; 50% owned smartphones) formally evaluated the materials with a majority (83.3%) electing to 'recommend the materials to others.' Lastly, 12 providers provided feedback on the materials and 79% rated the materials as helpful. Providers viewed the materials as especially useful for patients who are unable to return to clinic. Overall, providers and Veterans found the materials easy to understand and valuable for novice users. Findings suggest the use of user-centered design principles and iterative evaluations to create patient technology education materials are vital to increase the use of mental health mobile apps among older Veterans.

  View details for DOI 10.1037/pro0000354

  View details for PubMedID 34465939

  View details for PubMedCentralID PMC8404779

• Guided self-management targeting anxiety and activity participation in older Veterans. Aging & mental health Gould, C. E., Carlson, C., Wetherell, J. L., O'Hara, R., Goldstein, M. K., Loup, J. R., Ma, F., Beaudreau, S. A. 2020: 1–10

  Abstract

  Objectives: This study examined the acceptance, feasibility, and preliminary effects of a guided self-management intervention using video delivery and a telephone coach on anxiety and activity engagement.Method: Ten Veterans aged 60years or older with anxiety disorders determined by Structured Clinical Interview for Diagnostic and Statistical Manual 5th edition (SCID-5) at baseline visit participated in this non-randomized study examining a 4-week guided self-management intervention for anxiety. Feasibility was examined using participation engagement with the intervention. Measures of anxiety (Geriatric Anxiety Scale, PROMIS Anxiety Scale, Anxiety Control Questionnaire), depression (Patient Health Questionnaire 9-item), and activity participation (modified Activity Card Sort) administered at baseline and final (week 8) visit provided estimates of preliminary intervention effects. The Geriatric Anxiety Scale also was administered by phone at week 4. Participants completed a semi-structured qualitative interview at the final visit, which provided information about the acceptability, benefits of intervention, and barriers to engagement.Results: All participants (N=10) reported that the intervention somewhat or completely met their expectations, demonstrating intervention acceptability. Intervention completers (n=9) experienced reduced anxiety over the first 4weeks, alongside significant improvements in anxiety control and personalized activity goals across 8weeks. However, anxiety symptoms tended to return to baseline at follow-up. Participants identified the relaxation videos and promotion of a daily relaxation routine as the most helpful intervention components.Conclusions: Findings indicate that the intervention may improve activity participation and reduce anxiety. Thus, guided self-management interventions show promise for reducing distress and maintaining engagement later in life.

  View details for DOI 10.1080/13607863.2020.1758905

  View details for PubMedID 32397822

• Technology Use and Preferences for Mental Health Self-Management Interventions among Older Veterans. International journal of geriatric psychiatry Gould, C. E., Loup, J., Kuhn, E., Beaudreau, S. A., Ma, F., Goldstein, M. K., Wetherell, J. L., Zapata, A. M., Choe, P., O'Hara, R. 2019

  Abstract

  OBJECTIVES: The United States Department of Veterans Affairs offers numerous technology-delivered interventions to self-manage mental health problems. It is unknown, however, what barriers older military veterans face to using these technologies and how willing they would be to use technologies for mental health concerns.METHODS: Seventy-seven veterans (Mage =69.16years; SD=7.10) completed interviews in a concurrent mixed methods study. Interviewers asked about technology ownership and described four modalities of delivering self-management interventions: printed materials, DVDs, Internet, and mobile apps. Interviewers obtained feedback about each modality's benefits, barriers, and facilitators. Participants ranked their self-management modalities preferences alone and compared with counseling. Multi-variable adjusted logistic regression and qualitative analyses were conducted to investigate the reasons contributing to preferences.RESULTS: Most reported owning a computer (84.4%), having home Internet (80.5%), and a smartphone (70.1%). Participants preferred printed materials (35.1%) over mobile apps (28.6%), Internet (24.7%), and DVDs (13.0%). Lower computer proficiency was associated with preferring DVDs; higher proficiency was associated with Internet and mobile interventions. Residing in an urban area was associated with mobile apps. When counseling was an option, 66% identified this as their first preference. Qualitative findings showed veterans' desire for information, training, and provider support with technology.CONCLUSIONS: Older veterans reported high technology ownership rates, but varied preferences for self-management interventions. Notably, two-thirds preferred some form of technology, which points to the importance of ensuring that providers offer existing technology-delivered interventions to older veterans. Veterans' strong preference for counseling emphasizes the need for human support alongside self-management. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/gps.5252

  View details for PubMedID 31854029

• Relations of religion with depression and loneliness in older sexual and gender minority adults CLINICAL GERONTOLOGIST Escher, C., Gomez, R., Paulraj, S., Ma, F., Spies-Upton, S., Cummings, C., Brown, L. M., Tormala, T., Goldblum, P. 2019; 42 (2): 150-161

  Abstract

  High levels of religious involvement have been associated with positive mental health outcomes in older adults. This study investigated whether the effects of religion on healthy aging could generalize to older LGBTQ adults.This study examined religious affiliation in childhood versus at present, as well as the relationships of outness to religious community and religious engagement with depression and loneliness in 102 lesbian, gay, and bisexual cisgender, transgender, and questioning adults (LGBTQ) over the age of 55. As part of a larger study, participants completed several questions and measures including: one outness to religious community item, 4 religious engagement questions, the Center for Epidemiological Studies Depression Scale, and the 8-item UCLA Loneliness Scale.Many older LGBTQ adults reported changes in religious affiliation from childhood to adulthood. Greater levels of outness to religious communities and lower religious engagement were related to lower levels of depression and loneliness.Findings suggest that outness to religious communities may be beneficial to the mental health of older LGBTQ adults. Higher levels of distress may lead to higher levels of religious engagement.Religion, especially those that are supportive of sexual minorities, may help to improve the well-being of older LGBTQ adults.

  View details for DOI 10.1080/07317115.2018.1514341

  View details for Web of Science ID 000457862700003

  View details for PubMedID 30183539