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.

Keywords: depression; disability, tele-psychotherapy; homebound older adults.

Figure 1

Changes in predicted mean HAMD score.

Figure 2

Changes in predicted mean WHODAS score.

Figure 3

Parallel-process latent growth curve mediation model. Note. Gray paths indicate paths included in the model; coefficients are not displayed in order to simplify the figure. Notations within circles: T1 HAMD and T1 WHODAS: score changes from baseline to 12 weeks; 12-week HAMD and 12-week WHODAS: intercept at 12 weeks; and T2 HAMD and T2 WHODAS: score changes from 12 to 36 weeks.