Telemedicine-Delivered Psychotherapy for Older Veterans with Depression as Effective as In-Person Psychotherapy
BACKGROUND:
Depression is a serious and debilitating psychological disorder; approximately 6.5 million US adults older than 65 have the disorder. Depression is especially problematic for Veterans, with substantial depressive symptoms 2-5 times more likely than in their civilian counterparts. Cognitive behavioral therapies are the most recommended forms of psychotherapy for depression, however older Veterans may experience barriers to receiving care, such as mobility issues and living in rural areas. Telemedicine could increase access to evidence-based care for older Veterans; thus, this randomized controlled non-inferiority study assessed the efficacy of psychotherapy delivered to older Veterans via telemedicine in their homes. Between April 2007 and July 2011, Veterans (n=241) aged >58 were recruited from the Charleston, SC VAMC and 4 associated CBOCs and randomly assigned to either telemedicine or same-room psychotherapy. All patients received the same individual mental health intervention: 8 weeks of behavioral activation for depression. The primary outcome was treatment response: 50% reduction in symptoms from baseline to 12 months and no longer being diagnosed with major depressive disorder at 12 months, depending on the instrument used.
FINDINGS:
- Telemedicine-delivered psychotherapy for older Veterans with major depression produced outcomes that were no worse than in-person treatment delivery.
- Treatment response did not differ significantly between the telemedicine and same-room therapy groups on any of the instruments used.
- A high proportion of Veterans were rural residents (71%) and average session attendance was high (81% of Veterans in the telemedicine group completed all 8 sessions as did 79% of Veterans in the same-room group).
LIMITATIONS:
- Investigators conservatively excluded Veterans with acute safety concerns (suicidal or homicidal), substance dependence, and active psychosis or dementia.
- Very few women were included.
- Although the focus of the study was on behavioral treatment of depression, many Veterans were taking anti-depressant medications during the study, and these effects were not specifically tracked.
IMPLICATIONS:
Findings show that home-based telemedicine can be used to overcome barriers to care associated with distance from and difficulty with attendance at in-person sessions. Investigators suggest that resources be devoted to offering services directly into patients' homes via telemedicine methods.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 04-421). Drs. Egede, Acierno, Knapp, Lejuez, and Frueh, and Ms. Payne are part of HSR&D's Health Equity and Rural Outreach Innovation Center in Charleston, SC.
Egede L, Acierno R, Knapp R, Lejuez C, Hernandez-Tejada M, Payne E, Frueh B. Psychotherapy for Depression in Older Veterans via Telemedicine: A Randomized, Open-Label, Non-Inferiority Trial. Lancet Psychiatry August 2015;2(8):693-701.
