title: Six-month postintervention depression and disability outcomes of in-home telehealth problem-solving therapy for depressed, low-income homebound older adults.
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.
authors: The University of Texas at Austin, Austin, Texas.
authors: Namkee G
authors: NG
authors: Choi
authors: C Nathan
authors: CN
authors: Marti
authors: Martha L
authors: ML
authors: Bruce
authors: Mark T
authors: MT
authors: Hegel
authors: Nancy L
authors: NL
authors: Wilson
authors: Mark E
authors: ME
authors: Kunik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000628:therapy*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D018577:Homebound Persons / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000523:psychology; D011340:Problem Solving; D011613:Psychotherapy / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: depression; disability, tele-psychotherapy; homebound older adults