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 Many seniors face obstacles to getting help for depression,
including mobility issues and fear of social stigma, researchers
say, so telemedicine might expand their access to treatment.
“Psychotherapy works for depression whether you deliver it by
face-to-face or the telemedicine approach,” and telemedicine is a
good option for “older adults who have barriers to mobility, stigma,
or geographic isolation,” said lead author Dr. Leonard Egede
“At our facility, we have almost 40 percent of people who live in
rural areas, so this is a good opportunity to be able to provide
care for them without them having to drive long distances,” noted
Egede, the Allen H. Johnson Endowed Chair and professor of medicine
at the Medical University of South Carolina in Charleston, by email.
About 10 percent of the U.S. population will experience clinical
depression in their lifetimes, according to the Centers for Disease
Control and Prevention.
Among people over age 65, another 20 percent have “substantial”
depression symptoms that may not meet diagnostic criteria for the
full disorder, Egede and colleagues write in The Lancet Psychiatry.
This "minor depression" puts them at increased risk of progressing
to major depression, though, “and may warrant treatment,” the study
team adds.
Depression is a particular problem among veterans, whose risk is two
to five times that of the general population, the researchers note.
Another barrier for this group is disability, with many veterans
home-bound and unable to go to a clinic for care, Egede said.
Past studies have found telemedicine to be as effective as in-person
talk therapy for treating post-traumatic stress disorder, but there
has been less research on depression, he noted.
“Our goal was really to understand whether you can actually provide
good psychotherapy via telemedicine,” Egede said.
The researchers recruited 204 veterans over the age of 58 with
diagnosed major depressive disorder. They excluded patients who were
psychotic, suicidal or had addiction problems.
Participants were randomly divided into two groups, with members of
each receiving about eight one-hour therapy sessions, and a minimum
of four. Both groups got the identical treatment – behavioral
activation for depression, an approach that emphasizes reinforcing
positive behaviors.
One group received their therapy in traditional in-person sessions,
while the other group received treatment in their own homes,
speaking to a psychotherapist using a video phone that connected
over phone lines.
The study team measured the participants’ progress using two
standard questionnaires in which patients rated their own symptoms.
Participants were considered to be responding to treatment if their
symptoms were reduced by at least half.
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After four weeks, the questionnaires showed that only a small
proportion of patients in either group had reduced their symptoms by
that much, and only half as many in the telemedicine group (5
percent to 7 percent) as in the in-person therapy group (15
percent).
But by the three-month point, 15 percent of telemedicine patients
and 19 percent of in-person therapy patients were responding.
At the one-year mark, the groups were about even, with 19 percent to
22 percent of the telemedicine patients and 19 percent to 21 percent
of in-person patients meeting the treatment-response definition
based on the questionnaires.
At that point, the researchers also assessed improvement using a
structured clinical interview, in which a clinician determined if
the veterans would still be diagnosed with major depressive
disorder.
By that standard, 39 percent of telemedicine patients and 46 percent
of in-person therapy patients were no longer depressed. The small
percentage-point difference between the groups is not statistically
significant, meaning it could have been due to chance.
Although there were no adverse events during the study, Dr. Charles
Hoge, a psychiatrist and senior scientist at the Walter Reed Army
Institute of Research who wrote a commentary accompanying the study,
noted that in-home therapy raises the question of safety, because
there are no professionals present if an emergency arises.
“The most important consideration is ensuring that there are
procedures in place to address emergencies, such as if a patient
reports intent to commit suicide or homicide,” Hoge said in an
email.
Hoge noted, though, that he is optimistic about the use of
telemedicine. “It can expand patients’ options for receiving needed
mental health treatment,” he said.
SOURCE: bit.ly/1VLQBsK The Lancet Psychiatry, online July 16, 2015.
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