Six-Month Postintervention Depression and Disability Outcomes of in-Home Telehealth Problem-Solving Therapy for Depressed, Low-Income Homebound Older Adults

Abstract

Background Despite their high rates of depression, homebound older adults have limited access to evidence-based psychotherapy. The purpose of this paper was to report both depression and disability outcomes of telehealth problem-solving therapy (tele-PST via Skype video call) for low-income homebound older adults over 6 months postintervention. Methods A 3-arm randomized controlled trial compared the efficacy of tele-PST to in-person PST and telephone care calls with 158 homebound individuals who were aged 50+ and scored 15+ on the 24-item Hamilton Rating Scale for Depression (HAMD). Treatment effects on depression severity (HAMD score) and disability (score on the WHO Disability Assessment Schedule [WHODAS]) were analyzed using mixed-effects regression with random intercept models. Possible reciprocal relationships between depression and disability were examined with a parallel-process latent growth curve model. Results Both tele-PST and in-person PST were efficacious treatments for low-income homebound older adults; however the effects of tele-PST on both depression and disability outcomes were sustained significantly longer than those of in-person PST. Effect sizes (dGMA-raw) for HAMD score changes at 36 weeks were 0.68 for tele-PST and 0.20 for in-person PST. Effect sizes for WHODAS score changes at 36 weeks were 0.47 for tele-PST and 0.25 for in-person PST. The results also supported reciprocal and indirect effects between depression and disability outcomes. Conclusions The efficacy and potential low cost of tele-delivered psychotherapy show its potential for easy replication and sustainability to reach a large number of underserved older adults and improve their access to mental health services.

Depression, loneliness, and pet attachment in homebound older adult cat and dog owners

“…As such, homebound older adults are socially isolated and at significant risk for loneliness and depression (1,2). While existing interventions promote social integration and activities outside the home for older adults, most homebound older adults are functionally disabled, which limits their opportunity to participate in activities outside the home.…”

Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults

“…A number of studies demonstrated the effect of depression treatment on disability in healthy older adults (18, 19), yet there are few large-scale clinical trials investigating the impact of depression treatments on disability in low-income adults with physical limitations. A complexity of treating depression in low-income older adults is the limited access and acceptability of depression treatment.…”

Depresión como predictor de discapacidad en adultos mayores

“…En un estudio se compararon la psicoterapia presencial y la tele-psicoterapia (a través de llamadas por skype) y se informó que ambos fueron tratamientos eficaces para AM de bajos ingresos; sin embargo, los efectos sobre la depresión y la discapacidad (evaluados por el cambio en la puntuación del WHO-DAS), se mantuvieron por más tiempo en la psicoterapia a distancia en comparación con la presencial 52 . No obstante, el evaluar el efecto de intervenciones conductuales para prevenir o retrasar el inicio o la progresión tanto de la discapacidad como de la depresión en AM, sigue siendo un asunto pendiente.…”