Dr. Gould received her Ph.D in psychology from West Virginia University. She completed her internship at VA Palo Alto Health Care System and an Advanced Fellowship in Geriatrics at the GRECC. Dr. Gould is board certified in geropsychology. Her research program develops and tests tailored, self-directed mental health interventions in older adults. Her current funded studies are testing the efficacy of a video-delivered progressive muscle relaxation program with telephone coaching support in reducing anxiety and improving functioning and examining the use of technology by older Veterans. She is also is examining a mobile app-based intervention for depression in middle age and older adults. Dr. Gould has an active interest in training future geriatric mental health clinicians and researchers. She provides mentorship in the following areas: geriatric mental health interventions, technology-delivered interventions for older adults, program evaluation/quality improvement, and qualitative research methods.

Clinical Focus

  • Clinical Psychology

Academic Appointments

  • Clinical Associate Professor, Psychiatry and Behavioral Sciences

Professional Education

  • Internship: VA Palo Alto Health Care Psychology Training (2011) CA
  • PhD Training: West Virginia University - Dept of Psychology (2011) WV

Clinical Trials

  • Anxiety in Older Veterans Not Recruiting

    Anxiety leads to poor quality of life, avoidance of activities, decreased social engagement, functional decline, and disability in older patients. This study will compare two self-directed treatments delivered via Digital Versatile Disc (DVD) videos that can be viewed in one's own home. The two treatments being compared are: psychoeducation, which refers to information and education about anxiety, and a behavioral treatment program, called BREATHE (Breathing, Relaxation and Education for Anxiety Treatment in the Home Environment). BREATHE teaches diaphragmatic breathing and progressive muscle relaxation. Participants will be randomly assigned to either treatment. The study is 12 weeks long. There are 4 weeks of treatment via DVD and 8 weeks of follow-up. Participants will be asked questions about anxiety symptoms, mood, health and functioning.

    Stanford is currently not accepting patients for this trial.

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  • Meru Health Ascend Mobile Intervention for Depression in Middle Aged and Older Adults Not Recruiting

    Using technology to deliver depression interventions is one way could alleviate the public health burden of depression. The study is testing a mobile app intervention program for depression that uses cognitive behavioral skills and mindfulness. This study seeks to obtain feedback on the intervention and refine the intervention and then test the intervention in a larger study. The mobile app intervention called the Meru Health Ascend program consists of the app and therapist support via messaging within the app.

    Stanford is currently not accepting patients for this trial. For more information, please contact Christine Gould, PhD, 650-493-5000 Ext. 68899.

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  • Relaxation Treatment for Anxiety in Adults Aged 60 or Older Not Recruiting

    The PI developed a self-directed program to treat late-life anxiety called Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE). This program consists of weekly video lessons that participants watch on digital video disc (DVD) along with weekly telephone check-ins. In BREATHE participants will learn two behavioral interventions: diaphragmatic breathing and progressive muscle relaxation (PMR). The purpose of the study is to examine whether the self-directed BREATHE program is superior to a wait list control in reducing anxiety in older adults with anxiety disorders. For those assigned to wait list control, they will be offered opportunity to participate in BREATHE treatment after 8 weeks of wait list.

    Stanford is currently not accepting patients for this trial. For more information, please contact Christine E Gould, PhD, 650-493-5000 Ext. 68899.

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Graduate and Fellowship Programs

  • Geriatric Medicine (Fellowship Program)
  • Geriatric Psychiatry (Fellowship Program)

All Publications

  • Patterns and predictors of mental health service use among older veterans with alcohol use disorder who received a video-enabled tablet. Aging & mental health Alfaro, A. J., Greene, L., Van Campen, J., Zulman, D. M., Gould, C. E., Blonigen, D. M. 2023: 1-7


    Objectives: Video-based telehealth may expand access to mental health services among older veterans with alcohol use disorder (AUD). We examined the modalities through which mental health services were rendered, and predictors of video visits before and after video-enabled tablet receipt from the Veterans Health Administration.Method: 11,210 veterans aged 60 or older with a diagnosis of AUD who received a tablet between 1 April 2020 and 25 October 2021 were identified. The electronic health record was used to characterized encounters by modality of mental health care delivery in the sixmonths pre/post tablet receipt. Logistic regression examined predictors of a video visit for mental health.Results: Phone was the most common modality; however, the proportion of video encounters increased from 8.7% to 26.2% after tablet receipt. Individuals who were older, male, and had more physical health conditions, were less likely to have a video visit. Individuals who were married, resided in urban areas, had a history of housing instability, and had more mental health conditions, were more likely to have a video visit.Conclusion: Video-enabled tablets may help older adults with AUD overcome access barriers to mental health services, although targeted support for certain groups may be necessary.

    View details for DOI 10.1080/13607863.2023.2253448

    View details for PubMedID 37723897

  • Caregiver Experience of Tele-dementia Care for Older Veterans. Journal of general internal medicine Iyer, S. S., Ngo, V., Humber, M. B., Chen, P., Pallaki, M., Dolinar, T., Brodrick, M. B., Gould, C. E., Trivedi, R. B. 2023


    BACKGROUND: For the 5 million persons living with dementia (PLWD) in the USA, telemedicine may improve access to specialty care from their homes.OBJECTIVE: To elicit informal caregiver perceptions of tele-dementia care provided during COVID-19.DESIGN: Qualitative, observational study using grounded theory.PARTICIPANTS: Informal caregivers aged 18+who cared for an older adult who received tele-dementia services at two major VA healthcare systems participated in 30-60-min semi-structured telephone interviews.INTERVENTIONS: Interviews were designed using Fortney's Access to Care model.MAIN MEASURES: Thirty caregivers (mean age=67, SD=12, 87% women) were interviewed.KEY RESULTS: Five major themes were (1) Tele-dementia care avoids routine disruption and pre-visit stress; (2) Transportation barriers to in-person visits include not only travel logistics but navigating the sequelae of dementia and comorbid medical conditions. These include cognitive, behavioral, physical, and emotional challenges such as balance issues, incontinence, and agitation in traffic; (3) Tele-dementia care saves time and money and improves access to specialists; (4) Tele-dementia facilitated communication between caregiver and provider without hindering communication between PLWD and provider; and (5) Caregivers described ideal future dementia care as a combination of virtual and in-person modalities with in-home help, financial and medical support, and dementia-sensitive caregiver access. Caregivers interviewed saved 2.6h±1.5h (range: 0.5 to 6h) of travel time. Multiple caregivers described disruption of routines as difficult in PLWD and appreciated the limited preparation and immediate return to routine post telemedicine visit as positives.CONCLUSIONS: Caregivers found tele-dementia care convenient, comfortable, stress reducing, timesaving, and highly satisfactory. Caregivers would prefer a combination of in-person and telemedicine visits, with an opportunity to communicate with providers privately. This intervention prioritizes care for older Veterans with dementia who have high care needs and are at higher risk for hospitalization than their same age counterparts without dementia.

    View details for DOI 10.1007/s11606-023-08188-2

    View details for PubMedID 37131102

  • Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk. Contemporary clinical trials Beaudreau, S. A., Lutz, J., Wetherell, J. L., Nezu, A. M., Nezu, C. M., O'Hara, R., Gould, C. E., Roelk, B., Jo, B., Hernandez, B., Samarina, V., Otero, M. C., Gallagher, A., Hirsch, J., Funderburk, J., Pigeon, W. R. 2023: 107147


    Few clinical trials have examined brief non-pharmacological treatments for reducing suicide risk in older Veterans, a high-risk group. Problem Solving Therapy (PST) is a promising psychosocial intervention for reducing late life suicide risk by increasing adaptive coping to problems through effective problem solving and related coping skills. The current randomized clinical trial will compare the efficacy of six telephone-delivered sessions of Safety Planning (enhanced usual care; EUC) only or an updated version of PST (emotion-centered PST [EC-PST]) + EUC to determine the added clinical benefit of EC-PST for reducing severity of suicidal ideation and for increasing reasons for living, a critical protective factor. Participants randomized to EC-PST + EUC or EUC only will be 150 Veterans (75 each) with active suicidal ideation who are aged 60 or older; have a current DSM-5 anxiety, depressive, and/or trauma-related disorder; and without significant cognitive impairment. Primary outcomes (Geriatric Suicide Ideation Scale and Reasons for Living-Older Adults scale) will be assessed at 11 timepoints: baseline, after each of 6 treatment sessions, posttreatment, and at follow-up at 1, 3, and 6 months posttreatment, and analyzed using mixed effects modeling. Additionally, moderators and mediators of primary outcomes will be examined-functional disability, executive dysfunction, and problem-solving ability. Qualitative feedback from participants will identify potential Veteran-centric changes to the EC-PST protocol and to EUC. Ultimately, the goal of this study is to inform the evidence-based clinical practice guidelines for treatments to reduce suicide risk in older Veterans and specifically to inform clinical decision-making regarding the merit of adding EC-PST to EUC.

    View details for DOI 10.1016/j.cct.2023.107147

    View details for PubMedID 36921689

  • WHAT MATTERS MOST: A NEEDS ASSESSMENT OF OLDER ADULTS Pate, R., Cassidy-Eagle, E., Gould, C., Makowski, M., Herbst, S., Saxena, P., Kim, D., Wroolie, T., Therrien, S., Lin, F., Sommer, B., Thompson, D. ELSEVIER SCIENCE INC. 2023: S93
  • PSYCHOLOGICAL WELLNESS GROUP FOR OLDER ADULTS Eagle, E., Gould, C., Makowski, M., Herbst, S., Pate, R., Saxena, P., Kim, D., Wroolie, T., Therrien, S., Lin, F. V., Sommer, B., Gallagher-Thompson, D. ELSEVIER SCIENCE INC. 2023: S106-S107
  • Dementia "e"-consults for Behavioral and Psychological Symptoms of Dementia: Improving access to specialty dementia care for rural Veterans. Clinical gerontologist Iyer, S., Mehta, P., Gould, C. E., Gara, S., Brodrick, M. B., Tenover, J. L. 2023: 1-8


    OBJECTIVES: This paper characterizes a telephone-based e-consult program designed to assess and treat behavioral and psychological symptoms of dementia (BPSD) for older rural Veterans.METHODS: E-consults required geriatricians to conduct chart review and telephone calls to caregivers to determine behavior triggers, prior management attempts, and medications. Pharmacologic and non-pharmacological recommendations were provided with follow-up calls as needed.RESULTS: Evaluation of 364 Veterans (M age=80.8, 32% in rural/distal clinics) showed 97% (n=355) of E-consult interventions included caregiver dementia education to prepare them for managing disease progression and provide non-pharmacological strategies for BPSD. Ninety-four percent (n=244) of Veterans received medication guidance. A total of 37,504 travel miles was saved, with an average of 108miles for each Veteran.CONCLUSIONS: Findings support continued implementation of telephone and other virtual modalities of assessing and treating BPSD for older Veterans, thereby increasing access to dementia specialists, especially for rural older adults and their caregivers. A limitation to e-consults is the time needed to provide services compared to the maximum workload credit allowed.CLINICAL IMPLICATIONS: Virtual care improves access to Geriatric specialists and semi-urgent care that otherwise is not available. E-consults are effective in providing primary care providers guidance for diagnosis and management of dementia.

    View details for DOI 10.1080/07317115.2023.2177574

    View details for PubMedID 36773070

  • Supporting Veterans, Caregivers, and Providers in Rural Regions With Tele-Geriatric Psychiatry Consultation: A Mixed Methods Pilot Study. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry Gould, C. E., Carlson, C., Alfaro, A. J., Trivedi, R., Savell, A. D., Mehta, P. S., Burningham, Z., Peeples, A., Filips, J. 2023


    Cross-facility tele-geriatric psychiatry consultation is a promising model for providing specialty services to regions lacking sufficient geriatric psychiatry expertise. This evaluation focused on assessing the feasibility and acceptability of a consultation program developed by a geriatric psychiatrist in a Veterans Health Administration regional telehealth hub.Concurrent, mixed methods program evaluation.A region served by a VA health care system telehealth hub.Patients with at least 1 geriatric mental health encounter with a geriatric psychiatrist consultant during a 1 year-period; referring providers.Virtual psychiatric evaluation of Veterans with time-limited follow-up and e-consultation with providers.Interviews with consultant, medical record data, and referring provider surveys.Three hundred fifteen Veterans (M = 76.0 ± 9.64 years; 40% rural-dwelling) had 666 encounters (M = 2.11 ± 1.78) with most occurring via clinical video telehealth (n = 443; 67.6%), e-consultation (n = 99; 15.1%), or video to home (n = 95; 14.5%). Most encounters were related to neurocognitive disorders, depressive disorders, trauma-related disorders, or serious mental illness. Referring providers (N = 58) highly recommended the program, reported high satisfaction, followed through with recommendations, and believed that this program increased access to geriatric psychiatry.This single program was shown to be feasible, acceptable, and valued by the referring providers. The findings highlighted the complex presentations of Veterans referred, and the current unmet need of providers of such Veterans, providing impetus for wider implementation.

    View details for DOI 10.1016/j.jagp.2023.01.005

    View details for PubMedID 36754647

  • Insights about personality traits and cognitive performance and decline in adults 51-59Years old from the Wisconsin longitudinal study. International journal of geriatric psychiatry Beaudreau, S. A., Gould, C. E., Hantke, N. C., Kramer, A. O., Suresh, M., Jo, B., Fairchild, J. K. 2023; 38 (1): e5852


    OBJECTIVES: To delineate midlife personality dimensions of early cognitive change in an age-homogenous sample of U.S. older adults.DESIGN: Longitudinal study of 6133 adults from the Wisconsin Longitudinal Study (WLS).MEASURES: Middle-aged participants (mean age=53.2; SD=0.6) from the WLS completed the 'Big-5' personality assessment in 1992. Mixed effects models examined whether midlife personality traits were associated with change in cognitive performance from participant's mid-60s (2004-2005) to early 70s (2011). The cognitive battery assessed abstract reasoning (AR), category fluency (CF), working memory (WM), and delayed verbal memory (DVM). Models adjusted for sex, education, and subjective health.RESULTS: High Openness was a significant predictor of change in AR, CF, and DVM. These cognitive outcomes declined less among those with high Openness, but the effect sizes for Openness by time were small (R2 s<0.01). AR and CF were characterized by higher overall performance with high Openness, but with relatively parallel change for the highest and lowest Openness quartiles. There was no advantage of Openness to DVM by the second assessment. High Conscientiousness was a predictor of more change for DVM, though the effect size was small (R 2 <0.01).CONCLUSIONS: None of the midlife personality traits were uniformly associated with change in cognitive performance in early older adulthood. High midlife Openness had the most noteworthy impact on cognition. Interventions designed to target Openness have potential to elevate and maintain a higher threshold of performance in some cognitive domains, but may only have a small impact on cognitive change.

    View details for DOI 10.1002/gps.5852

    View details for PubMedID 36495530

  • Delivering Virtual Care to Patients with Cognitive Impairment within the Veterans Health Administration: Multi-level Barriers and Solutions. Journal of technology in behavioral science Gould, C. E., Iyer, S., Filips, J., Alfaro, A. J., Carlson, C., Trivedi, R. 2022: 1-9


    Older patients with cognitive impairment, including dementia, may benefit from virtual care that increases access to geriatric specialties. Here, we identify clinician-level strategies to address the numerous barriers that reduce utilization of virtual services. We describe two innovative programs in the Veterans Health Administration that deliver geriatric medicine and geriatric psychiatry services virtually. This commentary outlines concrete strategies addressing identified barriers, including technology access, digital literacy, and ambivalence and communication challenges during video visits. Two virtual care programs (tele-geriatric psychiatry consultation; tele-dementia care) that address complex medical and mental health issues in older adults with cognitive impairment are described. The Consolidated Framework for Implementation Research (CFIR) is used to categorize the clinician-level strategies and program elements as they relate to the implementation domains and constructs. Clinicians can use education strategies prior to and during virtual care visits to facilitate access to video, optimize the virtual experience, and promote information retention. These strategies rely on aspects of the inner setting, outer setting, and characteristics of individuals. The two virtual programs vary in their intervention characteristics and the inner setting, yet both programs share similar characteristics of individuals. Key elements contributing to adoption and sustainment of these virtual care programs for patients with cognitive impairment include the relative advantage of virtual care to leverage access to specialists over alternative solutions in each setting. Other factors to consider include the importance of communication, program champions, and the role of the Veterans Health Administration.

    View details for DOI 10.1007/s41347-022-00291-1

    View details for PubMedID 36530384

  • Geri-Mobile Health: Feasibility of a VA Mental Health Mobile Apps Coaching Program for Older Veterans. Clinical gerontologist Alfaro, A. J., Sakai, E., Carlson, C., Mehta, P. S., Anderson, J., Wynn, M., Gould, C. E. 2022: 1-12


    This program evaluation examined the feasibility, acceptability, and preliminary effects of an individualized coaching program to help older Veterans use VA mental health mobile apps to address mental health and well-being goals.The program delivers individual technical and clinical support to facilitate the use of mobile devices and VA apps. Participants completed assessments of mobile device proficiency, app use frequency, app comfort, quality of life, and mental health symptoms (completed by a subset, n = 11) pre- and post-participation.Of 24 enrollees, 17 completed the program and received an average of 7.58 (SD = 2.87) sessions including the initial assessment. Mobile device proficiency (t (16) = -3.80, p = .002) and number of days/week apps were used (t (16) = -2.34, p = .032) increased significantly from pre- to post-participation. Depressive and anxiety scores decreased significantly (t (10) = 3.16, p = .010; t (10) = 3.29, p = .008) among the subset completing those measures. Overall satisfaction was high; 100% reported they would recommend the program.Findings suggest the program is feasible, highly acceptable, and increases mobile device proficiency and use of apps.Coaching programs can equip older adults with the skills to use mental health apps.

    View details for DOI 10.1080/07317115.2022.2115433

    View details for PubMedID 35998237

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


    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

  • Enhancing specialty training in geropsychology competencies: an evaluation of a VA Geriatric Scholars Program advanced topics workshop. Gerontology & geriatrics education Gregg, J. J., Rodriguez, R. L., Mehta, P. S., Kramer, B. J., Gould, C. E. 2022: 1-10


    There is a growing need for psychologists with specialized training in geriatric mental health competencies. The Geriatric Scholars Program for Psychologists (GSP-P) was created to address this shortage within a large integrated healthcare system. In 2019, GSP-P piloted an advanced workshop designed to enhance expertise in geriatric mental health competencies among graduates of its foundational competencies core course. The workshop included 3.5days of expert-led seminars regarding the biopsychosocial needs of older adults with chronic medical illness and was followed by completion of an individualized learning plan. This paper describes the evaluation of the course using a mixed methods with data collected prior to the workshop, immediately post-workshop, and six months post-workshop. Results indicated enthusiasm for the workshop, significant improvements in four geropsychology domains on the Pikes Peak Geropsychology Knowledge and Skill Assessment Tool, and benefit from completion of the independent learning plans. Our findings demonstrate that continued enhancement of geropsychology competencies through advanced coursework is feasible and improves knowledge and skill, particularly when combined with individualized learning plans.

    View details for DOI 10.1080/02701960.2022.2069764

    View details for PubMedID 35491904

  • Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment. JMIR aging Mao, A., Tam, L., Xu, A., Osborn, K., Sheffrin, M., Gould, C., Schillinger, E., Martin, M., Mesias, M. 2022; 5 (2): e34326


    Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine.We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits.We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants' preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes.Survey respondents' (N=249) average age was 84.6 (SD 6.6) years, and 76.7% (n=191) of the participants were female. At site A, 88.9% (111/125) had a bachelor's degree or beyond, and 99.2% (124/125) listed English as their preferred language. At site B, 42.9% (51/119) had a bachelor's degree or beyond, and 13.4% (16/119) preferred English, while 73.1% (87/119) preferred Mandarin. Regarding video visits, 36.5% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24%), not being familiar with the technology (28/125, 22.4%), and having difficulty hearing (19/125, 15.2%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6%), lack of familiarity with technology and the internet (44/119, 36.9%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine.Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives.

    View details for DOI 10.2196/34326

    View details for PubMedID 35438648

  • Connecting Older Veterans with Mental Health Mobile Apps: a Survey of Provider and Staff Use of Apps and Patient Education Materials. Journal of technology in behavioral science Gould, C. E., Mehta, P. S., Carlson, C., Anderson, J. R., Alfaro, A. J., Sakai, E. Y. 2021: 1-6

    View details for DOI 10.1007/s41347-021-00236-0

    View details for PubMedID 34841046

  • Distinctions between depression and anxiety with fear of being a burden in late life. Aging & mental health Alfaro, A. J., Carlson, C., Segal, D. L., Gould, C. E. 2021: 1-6


    Objectives: The perception of being a burden is a well-known risk factor for dying by suicide. Research on factors that precede the state of perceived burdensomeness, such as fearing being a burden, is necessary. We investigated the extent to which health status, elevated depressive symptoms, and elevated anxiety symptoms are associated with fear of being a burden in late life.Method: Older adult participants (N=155) completed the Geriatric Anxiety Scale (GAS), Patient Health Questionnaire (PHQ-8), and demographic and health questions. Fear of being a burden, assessed with a supplemental item on the GAS, was categorically grouped as 'no fear' or 'some fear'. Using logistic regression, we examined predictors of fear of being a burden.Results: In the first step, elevated depression was associated with fear of being a burden (OR = 2.30, 95% CI: 1.09, 4.89, p = .03), but health status was not significant. In the second step, elevated anxiety was significant (OR = 2.63, 95% CI: 1.15, 5.99, p = .02); depression was no longer significant.Conclusion: Contrary to expectations, anxiety more strongly predicted fear of being a burden than depression. Future research should further investigate the role of anxiety in fear of being a burden and ways of intervening.

    View details for DOI 10.1080/13607863.2021.1993131

    View details for PubMedID 34713761

  • Problem Solving Training for Veterans with Complex Comorbidities: Treatment Delivery Adaptations during COVID-19. Clinical gerontologist Beaudreau, S. A., Otero, M. C., Walker, J. A., Gould, C. E., Sisco, S., White, P., Pella, K., Wiley, E., Voorhees, K., Wetherell, J. L. 2021: 1-14


    OBJECTIVES: To summarize adaptations due to COVID-19 for VA Problem Solving Training (PST) for clinicians serving medically complex patients and to compare patient mental health outcomes in the year before (2019) and during COVID-19 (2020).METHODS: Clinicians attended a multi-day workshop and up to 6 months of small-group consultation for two training cases. In 2019 and 2020, 122 Veteran patients completed baseline and posttreatment measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7 item), and negative problem-solving beliefs (Negative Problem Orientation Questionnaire). Qualitative data were collected on clinician's pandemic-related treatment implementation challenges.RESULTS: Program adaptations during COVID-19 addressed challenges due to delivering treatment by telephone, video, or in person; Veteran patient recruitment barriers; and privacy issues for telephone and video. Veterans in both pre-pandemic and COVID-19 cohorts had significant improvements in depression, anxiety, and negative problem-solving beliefs, with no significant differences in the amount of improvement between the two cohorts.CONCLUSIONS: Flexibilities afforded to clinicians delivering the PST training program during the pandemic addressed key obstacles and barriers to recruitment, and implementation did not diminish the effectiveness of the intervention.CLINICAL IMPLICATIONS: Findings support continued implementation of the PST training program with added flexibility to treatment delivery beyond the pandemic.

    View details for DOI 10.1080/07317115.2021.1963382

    View details for PubMedID 34405768

  • 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


    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

  • A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Chick, C. F., Singh, A., Anker, L. A., Buck, C., Kawai, M., Gould, C., Cotto, I., Schneider, L., Linkovski, O., Karna, R., Pirog, S., Parker-Fong, K., Nolan, C. R., Shinsky, D. N., Hiteshi, P. N., Leyva, O., Flores, B., Matlow, R., Bradley, T., Jordan, J., Carrion, V., O'Hara, R. 2021


    STUDY OBJECTIVES: Poor sleep impedes children's cognitive, emotional, and psychosocial development. Pediatric sleep dysregulation is common, and children who live in communities of low socioeconomic status (SES) experience additional risk factors for short sleep duration and poor sleep quality. School-based training in mindfulness and yoga-informed practices can improve children's behavior and well-being, but effects on objectively measured sleep are unknown.METHODS: Effects of a school-based health and mindfulness curriculum, which taught practices such as paced breathing, on sleep and stress were examined in 115 children (49 girls, ages eight to 11 at baseline). 58 children in a community of low socioeconomic status (SES) received the curriculum twice weekly for two years. 57 children in an SES-matched community engaged in their usual physical education class instead. In-home ambulatory polysomnography and perceived social stress were measured from all children at three timepoints: at baseline (i.e., prior to curriculum exposure) and at two yearly follow-ups.RESULTS: Children receiving the curriculum gained an average of 74 minutes of total sleep time, and 24 minutes of rapid eye movement (REM) sleep, per night over the two-year study period. Children not receiving the curriculum experienced a decrease in total sleep time averaging 64 minutes per night, with no changes in REM sleep. Sleep improved within the first three months of curriculum exposure, in a dose-dependent fashion. Higher curriculum engagement (e.g., using the breathing exercises outside of class) was associated with larger gains in total and REM sleep duration. Aggregate within-group changes in social stress were not significant. However, among children receiving the curriculum, those who experienced larger gains in total and REM sleep duration also experienced larger increases in perceived social stress.CONCLUSIONS: A school-based health and mindfulness curriculum improved children's objectively measured sleep over two years. Social stress did not mediate these effects; instead, mindfulness training may have increased awareness of environmental stressors, while developing tools to reduce stress vulnerability.

    View details for DOI 10.5664/jcsm.9508

    View details for PubMedID 34170222

  • A SCHOOL-BASED HEALTH AND MINDFULNESS CURRICULUM IMPROVES CHILDREN'S OBJECTIVELY MEASURED SLEEP Chick, C., Anker, L., Singh, A., Buck, C., Kawai, M., Gould, C., Cotto, I., Schneider, L., Linkovski, O., Matlow, R., Bradley, T., Carrion, V., O'Hara, R. OXFORD UNIV PRESS INC. 2021: A251
  • Converting a Geriatrics Clinic to Virtual Visits during COVID-19: A Case Study JOURNAL OF PRIMARY CARE AND COMMUNITY HEALTH Iyer, S., Mehta, P., Weith, J., Hoang-Gia, D., Moore, J., Carlson, C., Choe, P., Sakai, E., Gould, C. 2021; 12: 21501327211000235


    To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic.An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits.Veteran's Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment.Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19.Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings.Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication.During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.

    View details for DOI 10.1177/21501327211000235

    View details for Web of Science ID 000630908500001

    View details for PubMedID 33729044

    View details for PubMedCentralID PMC7975524

  • Improving Geropsychology Competencies of Veterans Affairs Psychologists JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Huh, J., Rodriguez, R. L., Gregg, J. J., Scales, A. N., Kramer, B., Gould, C. E. 2021; 69 (3): 798–805


    Older adults are more likely to seek mental health care through integrated care settings such as primary care. Currently, there exists a significant shortage of mental health providers trained in geropsychology and integrated care competencies. To address this need within the Veterans Health Administration, a national workforce development program was extended to include psychologists, which is called the Geriatric Scholars Program-Psychology Track (GSP-P). The GSP-P has two overarching educational program aims: (1) to improve geropsychology competencies of practicing VA psychologists, particularly those working within integrated settings (e.g., primary care) and (2) enrich psychologists' abilities to enact change in their clinical settings. Ninety-eight VA clinicians participated in the GSP-P, which includes a multi-day in-person course, from 2014 to 2018. Participants completed measures assessing confidence and self-reported knowledge in geropsychology and integrated care competencies pre-course and 3-months post-completion. Two-weeks post-course participants responded to open-ended survey questions regarding their perceptions of the course and potential applications of learning. Significant improvements in confidence in and knowledge of geropsychology and integrated care competencies emerged from pre-course to 3-months post-completion. Qualitative findings demonstrated that participants valued the face-to-face, integrated multimodal educational program. Findings provided insights regarding clinicians' planned application of the knowledge acquired, such as modifying treatments for older patients. Specialized workforce programs such as the GSP-P have a significant, positive impact on the care of older Veterans.

    View details for DOI 10.1111/jgs.17029

    View details for Web of Science ID 000607923300001

    View details for PubMedID 33453084

  • Depression, health comorbidities, cognitive symptoms and their functional impact: Not just a geriatric problem. Journal of psychiatric research Schüssler-Fiorenza Rose, S. M., Bott, N. T., Heinemeyer, E. E., Hantke, N. C., Gould, C. E., Hirst, R. B., Jordan, J. T., Beaudreau, S. A., O'Hara, R. 2021; 139: 185-192


    To compare the prevalence of cognitive symptoms and their functional impact by age group accounting for depression and number of other health conditions.We analyzed data from the 2011 Behavioral Risk Factor Surveillance System, a population-based, cross-sectional telephone survey of US adults. Twenty-one US states asked participants (n = 131, 273) about cognitive symptoms (worsening confusion or memory loss in the past year) and their functional impact (interference with activities and need for assistance). We analyzed the association between age, depression history and cognitive symptoms and their functional impact using logistic regression and adjusted for demographic characteristics and other health condition count.There was a significant interaction between age and depression (p < 0.0001). In adults reporting depression, the adjusted odds of cognitive symptoms in younger age groups (<75 years) were comparable or greater to those in the oldest age group (≥75 years) with a peak in the middle age (45-54 years) group (OR 1.9 (95% Confidence Interval: 1.4-2.5). In adults without depression, adults <75 years had a significantly lower adjusted odds of cognitive symptoms compared to the oldest age group with the exception of the middle-aged group where the difference was not statistically significant. Over half of adults under age 65 with depression reported that cognitive symptoms interfered with life activities compared to 35.7% of adults ≥65 years.Cognitive symptoms are not universally higher in older adults; middle-aged adults are also particularly vulnerable. Given the adverse functional impact associated with cognitive symptoms in younger adults, clinicians should assess cognitive symptoms and their functional impact in adults of all ages and consider treatments that impact both cognition and functional domains.

    View details for DOI 10.1016/j.jpsychires.2021.05.013

    View details for PubMedID 34087515

  • BRIEF VIDEO-DELIVERED INTERVENTIONS TO REDUCE ANXIETY IN OLDER VETERANS: A PILOT RCT Gould, C., Carlson, C., Anker, L., O'Hara, R., Wetherell, J., Goldstein, M., Beaudreau, S. OXFORD UNIV PRESS. 2021: 567
  • Changes in Quality of Life and Loneliness Among Middle-Aged and Older Adults Participating in Therapist-Guided Digital Mental Health Intervention. Frontiers in public health Gould, C. E., Carlson, C., Alfaro, A. J., Chick, C. F., Bruce, M. L., Forman-Hoffman, V. L. 1800; 9: 746904


    Background: This study aimed to examine the effects of a 12-week multicomponent mobile app-delivered intervention, the Meru Health Program (MHP), on mental health quality of life (QoL) and loneliness among the middle-aged and older adults with depression symptoms. Methods: The eligible participants (M age = 57.06, SD = 11.26 years) were enrolled in the MHP, a therapist-supported mobile intervention. Using a non-randomized pre-post design, change in mental health QoL [WHO QoL Brief (WHOQOL-BREF) psychological health] and loneliness (UCLA Loneliness Scale) from baseline to post-treatment were examined. Time of enrollment [pre- vs. post-coronavirus disease 2019 (COVID-19)] was included as a between-subjects factor in the repeated measures analyses. Results: Forty-two participants enrolled prior to the COVID-19 pandemic; eight enrolled after the pandemic began. Among the pre-COVID-19 enrollees, increase in mental health QoL, F (1, 38) = 12.61, p = 0.001, eta2 = 0.25 and decreases in loneliness emerged, F (1, 38) = 5.42, p = 0.025, eta2 = 0.13. The changes in mental health QoL, but not loneliness, held for the combined sample, such as post-COVID-19 enrollees, F (1, 44) = 6.02, p = 0.018, eta2 = 0.12. The regression analyses showed that increases in mindfulness were associated with the increased mental health QoL and decreased loneliness. Conclusion: Therapist-supported digital mental health interventions, such as the MHP, have the potential to improve mental health QoL and decrease loneliness among the middle-aged and older adults. The findings for loneliness may not hold during the periods of mandated isolation. Instead, therapists supporting digital interventions may need to tailor their approach to target loneliness.

    View details for DOI 10.3389/fpubh.2021.746904

    View details for PubMedID 34957011

  • Neurocognitive markers of passive suicidal ideation in late-life depression. International psychogeriatrics Jordan, J. T., Chick, C. F., Rolle, C. E., Hantke, N., Gould, C. E., Lutz, J., Kawai, M., Cotto, I., Karna, R., Pirog, S., Berk, M., Sudheimer, K., O'Hara, R., Beaudreau, S. A. 2020: 1–11


    OBJECTIVES: (1) To delineate whether cognitive flexibility and inhibitory ability are neurocognitive markers of passive suicidal ideation (PSI), an early stage of suicide risk in depression and (2) to determine whether PSI is associated with volumetric differences in regions of the prefrontal cortex (PFC) in middle-aged and older adults with depression.DESIGN: Cross-sectional study.SETTING: University medical school.PARTICIPANTS: Forty community-dwelling middle-aged and older adults with depression from a larger study of depression and anxiety (NIMH R01 MH091342-05 PI: O'Hara).MEASUREMENTS: Psychiatric measures were assessed for the presence of a DSM-5 depressive disorder and PSI. A neurocognitive battery assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains.RESULTS: The PSI group (n = 18) performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks, compared to the group without PSI (n = 22). The group with PSI had larger left mid-frontal gyri (MFG) than the no-PSI group. There was no association between cognitive flexibility/inhibitory ability and left MFG volume.CONCLUSIONS: Findings implicate a neurocognitive signature of PSI: poorer cognitive flexibility and poor inhibitory ability not better accounted for by other domains of cognitive dysfunction and not associated with volumetric differences in the left MFG. This suggests that there are two specific but independent risk factors of PSI in middle- and older-aged adults.

    View details for DOI 10.1017/S1041610220003610

    View details for PubMedID 33118918

  • Satisfaction with a Vacuum Constriction Device for Erectile Dysfunction among Middle-Aged and Older Veterans CLINICAL GERONTOLOGIST Beaudreau, S. A., Van Moorleghem, K., Dodd, S. M., Liou-Johnson, V., Suresh, M., Gould, C. E. 2020: 1–9


    To investigate satisfaction with a vacuum constriction device for middle-aged and older male Veterans with erectile dysfunction and their female partners.Patients (N = 57; mean age = 64.28 years; SD = 8.7) received comprehensive education and training and ongoing follow-up of device use, which included a semi-structured interview. Female partners (n = 41) also rated their satisfaction with the device.Over 96% of patients (n = 53/56 responses) endorsed the ability to maintain an erection with the device and 100% (n = 56/56 responses) indicated they would recommend the device to others. Female partners generally rated sex as better with the device (83.8%; n = 31/37 responses). Physical discomfort using the device was reported among 23% of patients (n = 16), and often due to difficulty or pain with the constriction bands. Difficulty obtaining erections with the device, though infrequently reported, was more common with older age.The majority of male patients and their female partners receiving comprehensive training for vacuum constriction device use reported satisfaction with the device.Vacuum constriction devices can be highly effective in improving the sexual health and intimacy of Veterans of all ages experiencing erectile dysfunction.

    View details for DOI 10.1080/07317115.2020.1823922

    View details for Web of Science ID 000574964000001

    View details for PubMedID 33012263

  • Developing a program to increase geropsychology competencies of Veterans Health Administration (VHA) psychologists GERONTOLOGY & GERIATRICS EDUCATION Huh, J., Rodriguez, R., Gould, C. E., R. Brunskill, S., Melendez, L., Kramer, B. 2020; 41 (4): 463–79


    There is an alarming supply and demand gap for geropsychology expertise within the United States. Health policy experts called for increasing geriatric mental health competencies for all mental health providers, including within Veterans Health Administration (VHA), to address this problematic gap. The VHA Geriatrics Scholar Program (GSP) Psychology Track was developed because there were no commercially available trainings in geropsychology for licensed psychologists. Developing the GSP Psychology Track was based on an evidence-based educational model for the VHA primary care workforce; and included a stepwise curriculum design, pilot implementation, and program evaluation. The educational program was pilot tested with eight VHA psychologists. Evaluation results demonstrated feasibility of implementing an innovative integrated multimodal educational program in geropsychology. Furthermore, this program was associated with reports of increased confidence in geropsychology competencies and self-reported implementation of geropsychology knowledge, indicating the potential for this educational model to improve mental health care for older Veterans.

    View details for DOI 10.1080/02701960.2018.1491402

    View details for Web of Science ID 000591843100019

    View details for PubMedID 29989527

  • Neurocognitive markers of passive suicidal ideation in late life depression Jordan, J. T., Chick, C. F., Rolle, C. E., Hantke, N., Gould, C. E., Lutz, J., Kawai, M., Cotto, I., Karna, R., Pirog, S., Berk, M., Sudheimer, K., O'Hara, R., Beaudreau, S. A. CAMBRIDGE UNIV PRESS. 2020: 160
  • Feasibility, Acceptance, and Initial Evaluation of a Telephone-Based Program Designed to Increase Socialization in Older Veterans. Journal of geriatric psychiatry and neurology Juang, C., Huh, J. W., Iyer, S., Beaudreau, S. A., Gould, C. E. 2020: 891988720944242


    Loneliness is a public health issue, particularly for older Veterans. To increase older Veterans' access for socialization opportunities, a community-based telephone-delivered activity program was developed, in which Veterans can call in and engage in social activities through telephone. This paper illustrates the feasibility, acceptance, and preliminary outcomes of this program using a mixed-methods design. Thirty-two Veterans enrolled in the program, with 14 attendees who called in to the program at least once. Attendees were more likely to be depressed than those who did not call in at baseline. Program was acceptable with high client satisfaction. Perceived benefits included a structured program with interesting topics to spend time on and the opportunity to socialize, exchange ideas, and connect with other Veterans. Individual challenges (e.g., hearing difficulty) and program-level challenges (e.g., complicated procedures) were reported during qualitative interviews. Among attendees, a significant decrease in loneliness from baseline to 3-months was found but should be interpreted with caution based on the small sample size. While positive findings emerged regarding feasibility, acceptance, preliminary benefits of this program, further refinement is needed to improve future program implementation.

    View details for DOI 10.1177/0891988720944242

    View details for PubMedID 32744165

  • 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. R., Scales, A. N., Juang, C., Carlson, C., Ma, F., Sakai, E. Y. 2020; 51 (4): 414–23

    View details for DOI 10.1037/pro0000354

    View details for Web of Science ID 000558746000012

  • 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


    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

  • Promoting Technology and Virtual Visits to Improve Older Adult Mental Health in the Face of COVID-19 AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Gould, C. E., Hantke, N. C. 2020; 28 (8): 889–90

    View details for DOI 10.1016/j.jagp.2020.05.011

    View details for Web of Science ID 000549708700017

    View details for PubMedID 32425468

    View details for PubMedCentralID PMC7227501

  • The 5-HTTLPR Long, not Short, Allele Predicts Two-year Longitudinal Increases in Cortisol and Declines in Verbal Memory in Older Adults. International journal of geriatric psychiatry Hirst, R. B., Jordan, J. T., Miryam Schussler-Fiorenza Rose, S., Schneider, L., Kawai, M., Gould, C., Anker, L., Chick, C. F., Beaudreau, S., Hallmayer, J., O'Hara, R. 2020


    OBJECTIVES: The short form or s-allele variant of the serotonin transporter polymorphism (5-HTTLPR), as compared with the long form or l-allele variant, has been associated with the presence of cognitive dysfunction, and particularly memory impairment in older adults. This body of cross-sectional work has culminated in the hypothesis that presence of the s-allele predicts greater memory decline in older adults (1). Yet, to date, there are no longitudinal studies which have investigated this issue.METHODS/DESIGN: Here we examine 109 community-dwelling older adults (mean and SD of age=70.7±8.7years) who underwent blood draw for genotyping, cognitive, and psychological testing at baseline, 12-month, and 24-month follow-up.RESULTS: Multilevel modeling found that s-allele carriers (ss or ls) performed worse than ll homozygotes at baseline on delayed verbal recall. Yet, s-allele carriers' memory performance was stable over the two-year follow-up period, while l-allele homozygotes experienced significant memory decline. l-allele homozygote status was associated with both increased cortisol and decreased memory over time, resulting in attenuated verbal memory performance differences compared to s-allele carriers with age.CONCLUSIONS: Overall, our findings do not support the hypothesis that presence of the 5-HTTLPR s-allele is a marker for memory decline in older adults. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/gps.5319

    View details for PubMedID 32400901

  • 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


    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

  • Examining Older Adult Cognitive Status in the Time of COVID-19 JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Hantke, N. C., Gould, C. 2020; 68 (7): 1387–89

    View details for DOI 10.1111/jgs.16514

    View details for Web of Science ID 000530734200001

    View details for PubMedID 32343394

    View details for PubMedCentralID PMC7267336

  • Patient Satisfaction With Geriatric Psychiatry Services via Video Teleconference AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Hantke, N., Lajoy, M., Gould, C. E., Magwene, E. M., Sordahl, J., Hirst, R., O'Hara, R. 2020; 28 (4): 491–94


    The objective for the current study is to examine patient satisfaction with geropsychiatry services provided via video telehealth.Participants included community-dwelling older Veterans receiving geriatric psychiatry services via telehealth across regions of the Pacific Northwest and Southwestern United States. Participants completed a paper-based survey examining satisfaction with services following the completion of two medication management visits with a geropsychiatrist.The majority of participants (90%) reported liking or even preferring geriatric telepsychiatry, despite the experience being novel for the majority of patients. Eighty-three percent of participants reported that receiving telegeropsychiatry services was the same (n = 30) or better (n = 3) than being seen in-person. Participants saved an average of 168 driving miles (means and standard deviations = 59.2; range 2-480) each visit.The findings of the current study suggest that older adults accept and are broadly satisfied with telegeropsychiatry services. This modality of care increased access to specialty care and decreased travel hardship.

    View details for DOI 10.1016/j.jagp.2019.08.020

    View details for Web of Science ID 000520856800014

    View details for PubMedID 31530457

  • Improvements in Functional Disability After Psychotherapy for Depression Are Associated With Reduced Suicide Ideation Among Older Adults. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry Lutz, J. n., Mackin, R. S., Otero, M. C., Morin, R. n., Bickford, D. n., Tosun, D. n., Satre, D. D., Gould, C. E., Nelson, J. C., Beaudreau, S. A. 2020


    To evaluate the association between changes in functional disability and suicide ideation among older adults following psychotherapy for depression.Sixty-five participants (65-91 years old, 72% White, and 66% female) with depression completed 12 sessions of problem solving therapy (PST) and completed measures of disability (WHO Disability Assessment Schedule 2.0) and suicide ideation (Geriatric Suicide Ideation Scale [GSIS]) at baseline and post-treatment.Hierarchical linear regressions found that reductions in functional disability were associated with overall reductions in suicide ideation on the GSIS (F[4,60] = 4.06, p < 0.01), particularly with the Loss of Worth GSIS subscale (F[4,60] = 7.86, p < 0.001, ΔR2 = 0.140).Results suggest decreased functional disability following depression treatment is associated with decreased suicide ideation, especially thoughts regarding loss of worth. These results highlight the potential for treatments that reduce functional disability (e.g., PST) to reduce risk of suicide among older adults.

    View details for DOI 10.1016/j.jagp.2020.09.021

    View details for PubMedID 33097388

  • 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


    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

  • A Case Report of Problem Solving Therapy for Reducing Suicide Risk in Older Adults with Anxiety Disorders. Clinical gerontologist Lutz, J., Mashal, N., Kramer, A., Suresh, M., Gould, C., Jordan, J. T., Wetherell, J. L., Beaudreau, S. A. 2019: 1–8


    Objectives: Suicide is a global public health problem among older adults. Problem-solving therapy (PST) has demonstrated promise in reducing late-life suicide risk, chiefly in secondary analyses of studies on late-life depression. PST mitigates negative beliefs about one's problem-solving abilities and maladaptive problem-solving styles, which suicidal older adults report. The effects of PST on suicide risk in older adults with primary anxiety disorder diagnoses have not been examined. Anxiety is a risk factor for suicide, but it is less studied in research on suicide compared to depression. This paper describes two cases of older individuals with anxiety disorders and suicidal ideation who completed six sessions of PST. Methods: Assessments of suicide risk, anxiety, depressive symptoms, and problem-solving ability were administered. Results: Both cases exhibited a clinically significant reduction in suicide risk, along with reductions in anxiety, worry, and depressive symptoms by posttreatment. Conclusions & Clinical Implications: Findings highlight the potential for PST as a psychotherapeutic intervention for reducing suicide risk in older adults with anxiety disorders.

    View details for DOI 10.1080/07317115.2019.1617378

    View details for PubMedID 31131742

  • Application of Problem Solving Therapy for Late-Life Anxiety COGNITIVE AND BEHAVIORAL PRACTICE Beaudreau, S. A., Gould, C. E., Mashal, N. M., Huh, J., Fairchild, J. 2019; 26 (2): 381–94
  • Veterans Affairs and the Department of Defense Mental Health Apps: A Systematic Literature Review PSYCHOLOGICAL SERVICES Gould, C. E., Kok, B. C., Ma, V. K., Zapata, A. L., Owen, J. E., Kuhn, E. 2019; 16 (2): 196–207


    In the present systematic review, we summarize the feasibility, usability, efficacy, and effectiveness of mental health-related apps created by the Veterans Affairs (VA) or the Department of Defense (DoD). Twenty-two articles were identified, reporting on 8 of the 20 VA/DoD mental health self-management and treatment companion apps. Review inclusion criteria were studies that reported original data on the usability, acceptability, feasibility, efficacy, and effectiveness, or attitudes toward the app. We collected data from each article regarding type of study, sample size, participant population, follow-up period, measures/assessments, and summary of findings. The apps have been tested with patients seeking treatment, patients with elevated mental health symptoms, and clinicians. The strongest area of support for the apps is regarding evidence of their feasibility and acceptability. Research support for efficacy and effectiveness of the apps is scarce with exceptions for two apps (PTSD Coach, Virtual Hope Box). Until more evidence accumulates, clinicians should use their judgment and be careful not to overstate the potential benefits of the apps. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for DOI 10.1037/ser0000289

    View details for Web of Science ID 000466773000003

    View details for PubMedID 30431306

  • Video-Delivered Relaxation Intervention Reduces Late-Life Anxiety: A Pilot Randomized Controlled Trial AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Gould, C. E., Kok, B. C., Ma, V. K., Wetherell, J., Sudheimer, K., Beaudreau, S. A. 2019; 27 (5): 514–25
  • Factors Associated with Supportive Care Service Use Among California Alzheimer's Disease Patients and Their Caregivers. Journal of Alzheimer's disease : JAD Newkirk, L. A., Dao, V. L., Jordan, J. T., Alving, L. I., Davies, H. D., Hewett, L. n., Beaudreau, S. A., Schneider, L. D., Gould, C. E., Chick, C. F., Hirst, R. B., Rose, S. M., Anker, L. A., Tinklenberg, J. R., O'Hara, R. n. 2019


    Existing literature on factors associated with supportive care service (SCS) use is limited. A better understanding of these factors could help tailor SCS to the needs of frequent users, as well as facilitate targeted outreach to populations that underutilize available services.To investigate the prevalence of SCS use and to identify factors associated with, and barriers to, service use.California Alzheimer's Disease Center patients with AD (n = 220) participated in the study from 2006-2009. Patients and their caregivers completed assessments to determine SCS use. Cognitive, functional, and behavioral status of the patients were also assessed. A two-part hurdle analysis identified 1) factors associated with any service use and 2) service use frequency among users.Forty percent of participants reported using at least one SCS. Patients with more impaired cognition and activities of daily living and more of the following: total number of medications, comorbid medical conditions, and years of education were more likely to use any SCS (p < 0.05). Factors associated with more frequent SCS use included younger age, more years of education, older age of AD onset, female gender, and having a spouse or relative for a caregiver (p < 0.05). Caregivers frequently indicated insufficient time as a reason for not receiving enough services.Factors associated with any SCS use mostly differed from those associated with SCS frequency, suggesting different characteristics between those who initiate versus those who continue SCS use. Our findings highlight the importance of targeted education on services and identifying barriers to long-term SCS use.

    View details for DOI 10.3233/JAD-190438

    View details for PubMedID 31743997

  • Video-Delivered Relaxation Intervention Reduces Late-Life Anxiety: A Pilot Randomized Controlled Trial. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry Gould, C. E., Kok, B. C., Ma, V. K., Wetherell, J. L., Sudheimer, K., Beaudreau, S. A. 2018


    OBJECTIVE: The study's aim was to demonstrate the feasibility and preliminary efficacy of a 4-week video-delivered relaxation program called Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE) for reducing anxiety and increasing activity engagement in older adults with anxiety disorders.METHODS: This was an 8-week pilot randomized controlled trial performed as outpatient and self-directed learning at home among 40 community-dwelling adults aged 60 years or older who met criteria for an anxiety disorder (generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, or anxiety disorder unspecified). The study looked at the BREATHE intervention compared with a wait list control condition. The primary outcome measure was anxiety symptoms (Geriatric Anxiety Scale). Secondary outcomes included activity engagement (modified Activity Card Sort), depressive symptoms (Patient Health Questionnaire), and somatic symptoms (Somatic Symptom Scale).RESULTS: In linear mixed-effects models, findings indicated a significant reduction in anxiety symptoms. There was no significant effect of group on activity engagement. Results also showed significant reductions in depressive and somatic symptoms associated with the BREATHE intervention compared with wait list.CONCLUSION: Our findings demonstrate feasibility and preliminary efficacy for this brief video-delivered relaxation intervention and suggest that older adults can benefit from technology-delivered interventions with minimal provider contact. Although activity engagement did not improve, lessons learned suggest that targeted coaching around activity goals may help target this outcome.

    View details for PubMedID 30765288

  • Validation of the Older Adult Social Evaluative Scale (OASES) as a measure of social anxiety INTERNATIONAL PSYCHOGERIATRICS Kok, B. C., Ma, V. K., Gould, C. E. 2018; 30 (9): 1323–32


    ABSTRACTBackground:Social anxiety disorder (SAD) (formerly called social phobia) is among the most common mental health diagnoses among older adults; however, the research on late-life social anxiety is scarce. A limited number of studies have examined the assessment and diagnosis of social anxiety disorder in this population, and there are few social anxiety measures that are validated for use with older adults. One such measure, the Older Adult Social Evaluative Scale (OASES), was designed for use with this population, but until now has lacked validation against a gold-standard diagnostic interview.Using a sample of 47 community-dwelling older adults (aged 60 years and over) with anxiety, the present study compared OASES performance to that of the Structured Clinical Interview for DSM-5 Disorders (SCID-5), as well as other measures of anxiety and depression.The OASES demonstrated convergent validity with other measures of anxiety, and demonstrated discriminant validity on other measures (e.g. depression, somatic symptoms). Receiver operating characteristic (ROC) analysis revealed that a cut-point of ≥76 optimized sensitivity and specificity compared to SCID-5 derived diagnoses of social anxiety disorder.This study is the first study to provide psychometric validation for the OASES and one of the first to administer the SCID-5 to an older adult sample. In addition to establishing a clinically significant cut-off, this study also describes the clinical utility of the OASES, which can be used to identify distressing situations, track anxiety severity, and monitor behavioral avoidance across a variety of social situations.

    View details for DOI 10.1017/S104161021700285X

    View details for Web of Science ID 000445999700008

    View details for PubMedID 29559015

  • Subjective but Not Objective Sleep is Associated with Subsyndromal Anxiety and Depression in Community-Dwelling Older Adults AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Gould, C. E., Karna, R., Jordan, J., Kawai, M., Hirst, R., Hantke, N., Pirog, S., Cotto, I., Rose, S., Beaudreau, S. A., O'Hara, R. 2018; 26 (7): 806–11
  • Subjective but Not Objective Sleep is Associated with Subsyndromal Anxiety and Depression in Community-Dwelling Older Adults. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry Gould, C. E., Karna, R., Jordan, J., Kawai, M., Hirst, R., Hantke, N., Pirog, S., Cotto, I., Schussler-Fiorenza Rose, S. M., Beaudreau, S. A., O'Hara, R. 2018


    OBJECTIVE: To examine the relationship between subclinical anxiety and depressive symptoms and objective sleep architecture measures and subjective sleep reports in older adults.METHODS: Community-dwelling older adults (N=167) self-rated their current severity of anxiety symptoms, depressive symptoms, daytime sleepiness, and global sleep quality. Participants received overnight ambulatory polysomnography to assess sleep architecture. Multivariate linear regression models examined associations between anxiety and depressive symptoms and objective and subjective sleep measures.RESULTS: Significant findings emerged for subjective sleep, with higher depression and anxiety scores associated with worse global sleep quality and greater anxiety scores associated with greater daytime sleepiness. No significant associations were observed between subclinical levels of anxiety or depressive symptoms with sleep architecture.CONCLUSION: Subclinical levels of late-life anxiety and depression have distinct associations with subjective sleep disturbance. Findings implicate subjective measures of sleep quality and daytime sleepiness as stronger trait markers for subthreshold psychiatric symptoms than objective sleep biomarkers.

    View details for PubMedID 29709510

  • Testing the usability of a portable DVD player and tailored photo instructions with older adult veterans EDUCATIONAL GERONTOLOGY Gould, C. E., Zapata, A. L., Shinsky, D. N., Goldstein, M. K. 2018; 44 (1): 64–73
  • Information-Seeking about Anxiety and Perceptions about Technology to Teach Coping Skills in Older Veterans CLINICAL GERONTOLOGIST Zapata, A. L., Beaudreau, S. A., O'Hara, R., Merrell, S., Bruce, J., Garrison-Diehn, C., Gould, C. E. 2018; 41 (4): 346–56


    We sought to learn where older veterans seek information about anxiety and coping. Due to increasing use of technology in health care, we also explored benefits and barriers of using technology to teach coping skills.Twenty veterans (mean age = 69.5 years, SD = 7.3) participated in semi-structured interviews in which we inquired about where they seek information about anxiety. We explored quantitative and qualitative differences for veterans with high versus low anxiety. In follow-up focus groups, we examined opinions about learning coping skills using technology.Though veterans primarily named health care professionals as sources of information about anxiety, online searches and reading books were frequently mentioned. Reported benefits of using technology were convenience and standardized instruction of coping skills. Barriers included lack of interaction and frustration with technology usability.Older veterans use multiple sources, heavily rely on interpersonal sources (e.g., professionals, friends), and employ varied search strategies regarding how to cope with anxiety. Using technology to teach coping skills was generally acceptable to older veterans.Health care professionals could guide patients towards credible online and book sources. Providing instruction about using technology may help older adults use technology to learn coping skills.

    View details for PubMedID 28967837

  • Unlocking Neurocognitive Substrates of Late-Life Affective Symptoms Using the Research Domain Criteria: Worry Is an Essential Dimension FRONTIERS IN AGING NEUROSCIENCE Beaudreau, S. A., Hantke, N. C., Mashal, N., Gould, C. E., Henderson, V. W., O'Hara, R. 2017; 9: 380


    While investigations have sought to identify the distinct and shared contributions of anxiety and depression to neurocognitive processes in late life, less is known regarding the further contribution of worry, a unique and critical dimension of affective dysregulation. Capturing the full range of symptoms, as inspired by the NIH Research Domain Criteria (RDoC), may provide finer-grained information on inter-relationships among worry, anxiety and depression on neurocognitive processing in later life. The objective of this study was to determine if the dimensional trait of worry intensifies known negative associations of dimensional measures of anxiety and depressive symptoms with neurocognitive processes, specifically cognitive control and memory processes. Using a cross-sectional and observational design, this study was conducted within a translational research center located with a Veterans medical center in Northern California. One hundred and nineteen community-residing older adults ages 65-91 years participated, and were characterized with psychiatric and neurocognitive dimensional measures. Affective symptom severity was assessed with the Penn State Worry Questionnaire, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory-II. Primary neurocognitive outcomes were inhibitory control assessed using a Stroop paradigm and delayed verbal memory assessed with the Rey Auditory Verbal Learning Test. Secondary outcomes included other less frequently examined cognitive control mechanisms (working memory, information processing, and verbal fluency) and memory processes (visual delayed memory). Contrary to prediction, the dimensional trait of worry attenuated negative associations between anxiety and depressive symptoms and inhibitory control on the one hand, and between depressive symptoms and delayed verbal memory processes on the other. In the secondary models, symptom dimensions were not associated with other cognitive control or visual delayed memory processes. Our fine-grained approach, in line with the NIMH RDoC model, suggests the neurocognitive processes associated with dimensional measures of late-life affective symptoms are dissociable. Specifically, dimensional measures of worry operate independently from other anxiety and depression symptoms to reveal differential patterns of neurocognitive processes associated with affective dysregulation.

    View details for PubMedID 29249958

  • Development of a video-delivered relaxation treatment of late-life anxiety for veterans. International psychogeriatrics Gould, C. E., Zapata, A. M., Bruce, J., Bereknyei Merrell, S., Wetherell, J. L., O'Hara, R., Kuhn, E., Goldstein, M. K., Beaudreau, S. A. 2017: 1-13


    Behavioral treatments reduce anxiety, yet many older adults may not have access to these efficacious treatments. To address this need, we developed and evaluated the feasibility and acceptability of a video-delivered anxiety treatment for older Veterans. This treatment program, BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment), combines psychoeducation, diaphragmatic breathing, and progressive muscle relaxation training with engagement in activities.A mixed methods concurrent study design was used to examine the clarity of the treatment videos. We conducted semi-structured interviews with 20 Veterans (M age = 69.5, SD = 7.3 years; 55% White, Non-Hispanic) and collected ratings of video clarity.Quantitative ratings revealed that 100% of participants generally or definitely could follow breathing and relaxation video instructions. Qualitative findings, however, demonstrated more variability in the extent to which each video segment was clear. Participants identified both immediate benefits and motivation challenges associated with a video-delivered treatment. Participants suggested that some patients may need encouragement, whereas others need face-to-face therapy.Quantitative ratings of video clarity and qualitative findings highlight the feasibility of a video-delivered treatment for older Veterans with anxiety. Our findings demonstrate the importance of ensuring patients can follow instructions provided in self-directed treatments and the role that an iterative testing process has in addressing these issues. Next steps include testing the treatment videos with older Veterans with anxiety disorders.

    View details for DOI 10.1017/S1041610217000928

    View details for PubMedID 28592349

  • Association of Anxiety Symptom Clusters with Sleep Quality and Daytime Sleepiness. journals of gerontology. Series B, Psychological sciences and social sciences Gould, C. E., Spira, A. P., Liou-Johnson, V., Cassidy-Eagle, E., Kawai, M., Mashal, N., O'Hara, R., Beaudreau, S. A. 2017


    To better understand links between anxiety and sleep disturbances in older adults, we examined the association of different phenotypic presentations of anxiety (i.e., affective, cognitive, and somatic clusters) with global sleep quality and daytime sleepiness.109 community-dwelling adults aged 66-92 years old (57% female) completed assessments of global sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), affective anxiety symptoms (Geriatric Anxiety Scale (GAS) affective subscale), cognitive anxiety symptoms (GAS cognitive subscale), and somatic anxiety symptoms (GAS somatic subscale).In hierarchical regression models adjusted for depressive symptoms and health status, greater affective and somatic anxiety were associated with poorer global sleep quality (affective B = 0.30, p = .01; somatic B = 0.41, p = .01). Somatic and cognitive anxiety were associated with greater daytime sleepiness (somatic B = 0.74, p < .001; cognitive B = 0.30, p = .03), but these associations were attenuated by covariates added to the models.These findings indicate that anxiety symptom clusters are differentially associated with specific sleep-related disturbances, underscoring the complex relationship of late-life anxiety to sleep. Results suggest that personalized treatments, such as targeted sleep interventions, may improve specific anxiety-symptom domains, or vice versa.

    View details for DOI 10.1093/geronb/gbx020

    View details for PubMedID 28379498

  • Handling clinical comorbidity in randomized clinical trials in psychiatry. Journal of psychiatric research O'Hara, R., Beaudreau, S. A., Gould, C. E., Froehlich, W., Kraemer, H. C. 2017; 86: 26-33


    The purpose of this paper is to a) outline the importance of including patients with clinical comorbidities in Randomized Clinical Trials (RCTs) of psychiatric treatments; and b) to propose a specific approach for best handling, analyzing and interpreting the data on clinical comorbidities in terms of their impact on treatment outcomes. To do this we first define and describe clinical comorbidity and differentiate it from other forms of comorbidity. We then describe the methodological and analytical problems associated with excluding patients with clinically comorbid conditions from RCTs, including the impact on the outcomes of RCTs in psychiatry and the impact on evidence-based clinical decision-making. We then address the challenges inherent to including patients with clinical comorbidities in RCTs. Finally, we propose a methodological and analytic approach to deal with these issues in RCTs which aims to significantly improve the information yielded from RCTs in psychiatry, and thus improve clinical decision-making.

    View details for DOI 10.1016/j.jpsychires.2016.11.006

    View details for PubMedID 27886637

  • Older adults report more sadness and less jealousy than young adults in response to worry induction. Aging & mental health Gould, C. E., Gerolimatos, L. A., Beaudreau, S. A., Mashal, N., Edelstein, B. A. 2017: 1-7


    The present study examined age differences in descriptions of the experience of worry and worry content.Twenty-eight older and 25 younger adults participated in an experimental manipulation of worry (i.e. 5-minute worry induction). Participants identified their three main worries and completed an emotion checklist before and after the induction.After the induction, younger adults endorsed feeling fearful, impatient, and irritated, whereas older adults endorsed feeling tense or worrying. Older adults were more likely than younger adults to report feeling sad (χ(2)(53) = 7.52, p = .01), whereas younger adults were marginally more likely to report feeling jealous (χ(2)(53) = 4.34, p = .05). With regards to worry content, older adults worried more about community/world affairs (χ(2) = 6.59, p = .01), whereas younger adults worried more about school (χ(2) = 17.61, p < .001). Only age differences in worry about school remained significant after applying the Holm-Bonferroni correction.Following a worry induction, older and younger adults endorsed a wide variety of negative affect beyond the typical emotions associated with worry. Greater sadness experienced by older compared with younger adults highlights the importance of considering negative affect states, particularly depression, when working with older adult worriers.

    View details for DOI 10.1080/13607863.2016.1277975

    View details for PubMedID 28112968

  • RESOLV: Development of a telephone-based program designed to increase socialization in older veterans EDUCATIONAL GERONTOLOGY Gould, C. E., Shah, S., Brunskill, S. R., Brown, K., Oliva, N. L., Hosseini, C., Bauer, E., Huh, J. 2017; 43 (8): 379–92
  • Longitudinal association of delta activity at sleep onset with cognitive and affective function in community-dwelling older adults. International journal of geriatric psychiatry Kawai, M., Beaudreau, S. A., Gould, C. E., Hantke, N. C., Cotto, I., Jordan, J. T., Hirst, R. B., O'Hara, R. 2016; 31 (10): 1124-1135


    This investigation sought to determine whether delta activity at sleep onset (DASO) in the sleep electroencephalography of older adults represents normal variation or is associated with clinical pathology. To this end, we examined its longitudinal associations with cognitive and affective function in older adults without dementia.Participants were 153 community-dwelling older adults without dementia. We evaluated polysomnography (PSG), cognitive performance, and affective function at four time points: baseline, 12, 24, and 36 months. All participants completed PSG and measures of global cognition, delayed verbal memory, information processing speed, attention, inhibition, verbal naming, visuospatial ability, and measures of anxiety and depression. DASO was defined as sequences of rhythmic anterior delta activity on PSG in the transition from awake to sleep during the baseline assessment (Figure ).At the baseline, 83 women and 70 men, mean age 71.3 ± 0.6 years participated and 19.6% of participants exhibited DASO. Age, years of education, gender, and body mass index did not differ according to DASO status. Linear mixed modeling showed that the presence of DASO was actually associated with lower levels of anxiety and depression. Further, participants with DASO, versus those without DASO, exhibited a trend towards better cognitive performance over time, although none of these associations reached statistical significance.Whereas DASO was associated with better affective function, no significant association was found between DASO and cognitive change over time. These longitudinal findings support the view that the presence of DASO in healthy older adults represents normal variation rather than pathological aging. Copyright © 2016 John Wiley & Sons, Ltd.

    View details for DOI 10.1002/gps.4554

    View details for PubMedID 27554208

  • Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. International journal of geriatric psychiatry Gould, C. E., O'Hara, R., Goldstein, M. K., Beaudreau, S. A. 2016; 31 (10): 1105-1115


    The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms.A sample of 4219 participants (65 years or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models' outcome was elevated anxiety (≥12 on five-item Beck Anxiety Inventory) or depressive symptoms (≥12 on eight-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of seven self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses.Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95% confidence interval: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of seven medical conditions, with the exception being stroke, were present in the majority of triads.Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. As anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

    View details for DOI 10.1002/gps.4532

    View details for PubMedID 27441851

  • Delta Activity at Sleep Onset and Cognitive Performance in Community-Dwelling Older Adults SLEEP Kawai, M., Beaudreau, S. A., Gould, C. E., Hantke, N. C., Jordan, J. T., O'Hara, R. 2016; 39 (4): 907-914


    Frontal intermittent rhythmic delta activity (FIRDA) has long been considered to be an abnormal variant in the electroencephalogram (EEG) among older adults. Prior work also indicates a predominance of slow wave EEG activity among patients with dementia. However, instability of state control occurring with aging generally and among many neurodegenerative diseases raises the possibility that FIRDA might represent the intrusion of sleep related elements of the EEG into the waking state. We examined delta activity at sleep onset (DASO) in community-dwelling, older adults without dementia, and examined whether this activity is related to poorer cognitive performance.153 community-dwelling, older adults without dementia underwent overnight polysomnography and measures of global cognition, delayed verbal memory, information processing speed, attention, inhibition, verbal naming, and visuospatial ability. Delta activity during sleep/wake transitions (scored either as Waking or N1) was analyzed visually.Participants were 83 women and 70 men, mean age 71.3 ± 0.6 y. DASO was present in 30 participants (19.6%). Age, years of education, sex, and body mass index did not differ between DASO (+) and (-) groups. Multiple regression analyses indicated faster reading of the Stroop color words in DASO (+) subjects (P = 0.007). None of the other cognitive domains differed between the two groups.DASO was relatively common in our sample of community-dwelling, older adults without dementia. DASO was not associated with poorer performance on any cognitive domain. Instead, individuals with DASO demonstrated better performance on a simple reading task. Although these findings suggest that an abnormal EEG activity may represent normal variation, our work underscores the importance of distinguishing DASO from FIRDA when examining sleep in older adults.A commentary on this article appears in this issue on page 725.

    View details for DOI 10.5665/sleep.5652

    View details for Web of Science ID 000373186900022

    View details for PubMedCentralID PMC4791624

  • Perceived anxiety control is associated with sleep disturbance in young and older adults AGING & MENTAL HEALTH Gould, C. E., Beaudreau, S. A., O'Hara, R., Edelstein, B. A. 2016; 20 (8): 856-860


    This study examined the extent to which perceived anxiety control was related to subjective sleep disturbance in young and older adults.Fifty-one young adults (18 to 30 years old) and 48 older adults (aged 65 years and older) completed questionnaires including the Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbance, Anxiety Control Questionnaire to assess perceived control over anxiety, a perceived health rating, and demographic questionnaire. Correlation and multivariable adjusted hierarchical regression analyses examined the extent to which anxiety control was associated with sleep disturbance.Anxiety control and health status were associated with global sleep quality on the PSQI, but no age differences in PSQI scores were found. In post hoc analyses, greater anxiety control was related to shorter sleep latency. Both older age and greater anxiety control were associated with less daytime dysfunction, whereas only older age was associated with better sleep quality.Although some variations in sleep quality by age were found, overall findings suggest that perceived anxiety control contributes to sleep disturbance in young and older adults. Greater anxiety control could lead to shorter sleep latency through reduced anxiety and worry symptoms at bedtime. Future studies should examine whether improved anxiety control with psychological treatments is one mechanism through which beneficial and lasting effects on sleep disturbance can be achieved.

    View details for DOI 10.1080/13607863.2015.1043617

    View details for Web of Science ID 000379246300011

    View details for PubMedID 26023761

  • Implementation of a brief anxiety assessment and evaluation in a Department of Veterans Affairs geriatric primary care clinic JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT Gould, C. E., Beaudreau, S. A., Gullickson, G., Tenover, J., Bauer, E. A., Huh, J. 2016; 53 (3): 335–43


    Anxiety disorders are common and debilitating in older individuals, yet anxiety is often not formally assessed in primary care. We conducted a quality improvement project to examine the feasibility of implementing a brief anxiety assessment, the Geriatric Anxiety Inventory (GAI), in a Department of Veterans Affairs geriatric primary care clinic. We compared the GAI with a depression assessment, the 15-item Geriatric Depression Scale (GDS-15). Fifty older Veterans (mean = 78.5 +/- 7.4 yr) completed the GAI and GDS-15. Mean completion time and feedback to patients was brief (6.20 min; n = 10). Good internal consistency (alpha = 0.82) was found for GAI scores. Patients with psychiatric diagnoses obtained significantly higher GAI scores (mean = 4.73 +/- 1.15) compared with patients without psychiatric diagnoses (mean = 1.15 +/- 1.86, t(11.46) = -3.10, p = 0.01). Findings suggest that the GAI is acceptable to patients but may not be suitable for differentiating anxiety symptoms or disorders from depression. Interdisciplinary team members continued to implement the GAI after project completion to screen for and track anxiety symptoms in our geriatric primary care patients. Detecting anxiety with the GAI had the benefit of allowing providers to initiate conversations about available treatments and track symptoms as part of noting treatment progress.

    View details for Web of Science ID 000375731700004

    View details for PubMedID 27273145

  • Evaluation of a Dementia Resource Fair for Veterans, Caregivers, and Staff. Federal practitioner : for the health care professionals of the VA, DoD, and PHS Gould, C. E., McConnell, K. n., Wexler, B. n., Scanlon, B. K. 2016; 33 (10): 42–46


    The resource fairs were well received and provided a good opportunity to improve education for patients, their families, and health care providers.

    View details for PubMedID 30766144

  • Disability and Treatment Outcomes for Anxiety and Depression in Older Veterans CLINICAL GERONTOLOGIST Gould, C. E., Huh, J., Brunskill, S. R., McConnell, K., Tenover, J. 2015; 38 (4): 268–82
  • Depression and anxiety symptoms in male veterans and non-veterans: the Health and Retirement Study INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Gould, C. E., Rideaux, T., Spira, A. P., Beaudreau, S. A. 2015; 30 (6): 623–30


    We examined whether veteran status was associated with elevated depression and anxiety symptoms in men aged 50 and older after adjusting for sociodemographic factors.Participants were 6577 men aged 50 years and older who completed the 2006 wave of the Health and Retirement Study (HRS). Forty-nine percent of participants were veterans. A randomly selected subset of participants completed the HRS Psychosocial Questionnaire (N = 2957), which contained the anxiety items. Elevated depression and anxiety symptoms were determined based on brief versions of Center for Epidemiologic Studies--Depression Scale (CES-D total score ≥ 4) and Beck Anxiety Inventory (BAI total score ≥ 12).Elevated depression and anxiety symptoms were found in 11.0 and 9.9% of veterans, respectively, compared with 12.8 and 12.3% of non-veterans. Veteran status was not associated with increased odds of anxiety or depression symptoms in the multivariable-adjusted logistic regression analyses. Additional analyses indicated that Vietnam War veterans were more than twice as likely as World War II or Korean War veterans to have elevated depression symptoms (OR = 2.15, 95% CI: 1.54-3.00) or anxiety symptoms (OR = 2.12, 95% CI: 1.28-3.51).In a community-based sample of men aged 50 and older, veteran status was not associated with the presence of elevated depression and anxiety symptoms. Rather, these symptoms were associated with age, ethnicity, education, and medical conditions. Among veterans, cohort effects accounted for differences in psychiatric symptoms. Including younger cohorts from the Global War on Terror may yield different results in future studies.

    View details for DOI 10.1002/gps.4193

    View details for Web of Science ID 000355985600010

    View details for PubMedID 25145943

    View details for PubMedCentralID PMC4336840

  • Anxiety Symptom Clusters Predict Sleep Quality Gould, C. E., O'Hara, R., Cassidy-Eagle, E. L., Liou-Johnson, V., Beaudreau, S. A. ELSEVIER SCIENCE INC. 2015: S144–S145
  • Measuring anxiety in late life: A psychometric examination of the Geriatric Anxiety Inventory and Geriatric Anxiety Scale JOURNAL OF ANXIETY DISORDERS Gould, C. E., Segal, D. L., Yochim, B. P., Pachana, N. A., Byrne, G. J., Beaudreau, S. A. 2014; 28 (8): 804–11


    We examined the psychometric properties, internal scale reliability and validity, of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and Geriatric Anxiety Scale (GAS). We also determined the extent to which memory ability influenced the psychometric properties of these measures. Older adult participants (N=110; M age=75 years) completed self-report, clinician-rated and diagnostic psychiatric measures and a neuropsychiatric battery. GAI and GAS scores had good internal consistency, adequate reliability, and strong convergent validity. GAI scores had better discriminant validity than GAS scores relative to a health rating. Both measures had strong associations with depression scores. Psychometric properties were decreased in participants with average delayed memory recall compared with those with superior recall. Both measures had good psychometric support, particularly in those with strong memory abilities. Psychometric performance characteristics indicate that the GAI and GAS may be good alternatives to anxiety measures not designed specifically for older adults.

    View details for DOI 10.1016/j.janxdis.2014.08.001

    View details for Web of Science ID 000346540200010

    View details for PubMedID 25271176

  • Association between depression and anxiety on blood pressure dysregulation and pulse in the Health and Retirement Study INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Gould, C. E., Beaudreau, S. A. 2013; 28 (10): 1045-1053


    OBJECTIVE: Extreme blood pressure (BP) values are associated with symptoms of anxiety and depression, but findings from studies are conflicting. The present study tested linear and curvilinear models of the association between anxiety and depression symptoms and BP in the Health and Retirement Study. The relationship between anxiety and depressive symptoms and pulse was also tested. METHOD: Participants were aged 50 to 104 (N = 4179) and completed the Health and Retirement Study Psychosocial Questionnaire and Physical Measurements in 2006. BP and pulse were measured using an automated cuff. The means of three BP and pulse measurements taken 45 to 60 s apart were used. Depressive and anxiety symptoms were measured with brief forms of the Center for Epidemiological Studies Depression Scale and Beck Anxiety Inventory. RESULTS: Ordinal regression analyses examined the relationship between BP and anxiety and depressive symptoms. In models adjusted for medical illness and medications, anxiety was associated with systolic hypotension, and depression was associated with diastolic hypotension. Higher pulse was associated with depression but not anxiety. CONCLUSIONS: Findings suggest that BP dysregulation, specifically hypotension, may be a useful indicator of anxiety and depression. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

    View details for DOI 10.1002/gps.3926

    View details for Web of Science ID 000323844800008

    View details for PubMedID 23335009

  • Diabetes is associated with cognitive impairment no dementia in the aging, demographics, and memory study (ADAMS) INTERNATIONAL PSYCHOGERIATRICS Gould, C. E., Beaudreau, S. A., Salman, H. 2013; 25 (1): 167-168

    View details for DOI 10.1017/S1041610212001196

    View details for Web of Science ID 000312528400020

    View details for PubMedID 22835854