A naturalistic study of the acceptability and effectiveness of internet-delivered cognitive behavioural therapy for psychiatric disorders in older australians.
OBJECTIVE
The current study investigates the acceptability, effectiveness and uptake of internet-delivered cognitive behavioural therapy (iCBT) amongst older individuals (>60 years) seeking psychiatric treatment in general practice.


METHODS
The sample consisted of 2413 (mean age 39.5; range 18-83 years) patients prescribed iCBT through This Way Up clinic by their primary care clinician. The intervention consisted of six fully automated, unassisted online lessons specific to four disorders major depression, generalised anxiety disorder, panic disorder or social phobia. Patients were categorised into five age groups (18-29 years, 30-39 years, 40-49 years, 50-59 years, 60 years and above). 225 (9.3%) patients were aged over 60 years. Analyses were conducted across the four disorders to ensure sufficient sample sizes in the 60 years and older age group. Age differences in adherence to the six lesson courses were assessed to demonstrate acceptability. Age-based reductions in psychological distress (Kessler Psychological Distress Scale; K10) and disability (the World Health Organisation Disability Assessment Schedule; WHODAS-II) were compared to demonstrate effectiveness. To evaluate the uptake of iCBT, the age distribution of those commencing iCBT was compared with the prevalence of these disorders in the 2007 Australian National Survey of Mental Health and Well-Being.


RESULTS
Older adults were more likely to complete all six lessons when compared with their younger counterparts. Marginal model analyses indicated that there were significant reductions in the K10 and WHODAS-II from baseline to post-intervention, regardless of age (p<0.001). The measurement occasion by age interactions were not significant, indicating that individuals showed similar reductions in the K10 and WHODAS-II regardless of age. In general, the age distribution of individuals commencing the iCBT courses matched the age distribution of the four diagnoses in the Australian general population, indicating that iCBT successfully captures older individuals who need treatment.


CONCLUSIONS
iCBT is effective and acceptable for use in older populations.
Centre for Healthy Brain and Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia. louisem@unsw.edu.au
Louise
L
Mewton
Perminder S
PS
Sachdev
Gavin
G
Andrews
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D061108:Social Media; D016896:Treatment Outcome; D055815:Young Adult