Telehealth Problem-Solving Therapy for Depressed Low-Income Homebound Older Adults

Am J Geriatr Psychiatry. 2014 Mar;22(3):263-71. doi: 10.1097/JGP.0b013e318266b356.

Abstract

Objective: To evaluate the acceptance and preliminary efficacy of in-home telehealth delivery of problem-solving therapy (tele-PST) among depressed low-income homebound older adults in a pilot randomized control trial designed to test its feasibility and preliminary efficacy.

Methods: A total of 121 homebound individuals who were age 50+ and scored 15+ on the 24-item Hamilton Rating Scale for Depression (HAMD) participated in the three-arm randomized control trial, comparing tele-PST with in-person PST and telephone support calls. Six sessions of the PST-primary care were conducted for the PST participants. For tele-PST, sessions 2-6 were conducted via Skype video call. Acceptance of tele-PST or in-person PST was measured with the 11-item, 7-point scale modified Treatment Evaluation Inventory (TEI). A mixed-effect regression analysis was used to examine the effects of treatment group, time, and the interaction term between treatment group and time on the HAMD scores.

Results: The TEI score was slightly higher among tele-PST participants than among in-person PST participants. The HAMD scores of tele-PST participants and in-person PST participants at a 12-week follow-up were significantly lower than those of telephone support call participants, and the treatment effects were maintained at a 24-week follow-up. The HAMD scores of tele-PST participants did not differ from those of in-person PST participants.

Conclusions: Despite their initial skepticism, almost all participants had extremely positive attitudes toward tele-PST at the 12-week followup. Tele-PST also appears to be an efficacious treatment modality for depressed homebound older adults and to have significant potential to facilitate their access to treatment.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / psychology*
  • Cognitive Behavioral Therapy*
  • Depression / therapy*
  • Female
  • Homebound Persons / psychology*
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care
  • Pilot Projects
  • Poverty / psychology*
  • Problem Solving
  • Telemedicine*
  • Treatment Outcome