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SIX-MONTH POSTINTERVENTION DEPRESSION AND DISABILITY OUTCOMES OF IN-HOME TELEHEALTH PROBLEM-SOLVING THERAPY FOR DEPRESSED, LOW-INCOME HOMEBOUND OLDER ADULTS

Authors

  • Namkee G. Choi Ph.D.,

    Corresponding author
    1. The University of Texas at Austin, Austin, Texas
    • Correspondence to: Namkee G. Choi, The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd., D3500, Austin, TX 78712. E-mail: nchoi@austin.utexas.edu

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  • C. Nathan Marti Ph.D.,

    1. The University of Texas at Austin, Austin, Texas
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  • Martha L. Bruce Ph.D., M.P.H.,

    1. Weill Cornell Medical College, White Plains, New York
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  • Mark T. Hegel Ph.D.,

    1. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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  • Nancy L. Wilson M.A., M.S.W.,

    1. The Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas
    2. VA Health Services Research and Development Center of Excellence, Baylor College of Medicine, Houston, Texas
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  • Mark E. Kunik M.D., M.P.H.

    1. The Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas
    2. VA Health Services Research and Development Center of Excellence, Baylor College of Medicine, Houston, Texas
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  • Contract grant sponsor: National Institute of Mental Health; Contract grant number: R34 MH083872; Contract grant sponsor: VA HSR&D Center for Innovations in Quality, Effectiveness and Safety; Contract grant number: CIN 13-413.

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.

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