Choi Namkee G, Hegel Mark T, Marti Nathan, Marinucci Mary Lynn, Sirrianni Leslie, Bruce Martha L
Am J Geriatr Psychiatry. 2014 Mar;22(3):263-71. doi: 10.1097/JGP.0b013e318266b356.
To evaluate the acceptance and preliminary efficacy of in-home telehealth delivery of problem-solving therapy (tele-PST) among depressed low-income homebound older adults in a pilot randomized control trial designed to test its feasibility and preliminary efficacy.
A total of 121 homebound individuals who were age 50+ and scored 15+ on the 24-item Hamilton Rating Scale for Depression (HAMD) participated in the three-arm randomized control trial, comparing tele-PST with in-person PST and telephone support calls. Six sessions of the PST-primary care were conducted for the PST participants. For tele-PST, sessions 2-6 were conducted via Skype video call. Acceptance of tele-PST or in-person PST was measured with the 11-item, 7-point scale modified Treatment Evaluation Inventory (TEI). A mixed-effect regression analysis was used to examine the effects of treatment group, time, and the interaction term between treatment group and time on the HAMD scores.
The TEI score was slightly higher among tele-PST participants than among in-person PST participants. The HAMD scores of tele-PST participants and in-person PST participants at a 12-week follow-up were significantly lower than those of telephone support call participants, and the treatment effects were maintained at a 24-week follow-up. The HAMD scores of tele-PST participants did not differ from those of in-person PST participants.
Despite their initial skepticism, almost all participants had extremely positive attitudes toward tele-PST at the 12-week followup. Tele-PST also appears to be an efficacious treatment modality for depressed homebound older adults and to have significant potential to facilitate their access to treatment.
在一项旨在测试其可行性和初步疗效的试点随机对照试验中，评估针对居家的低收入抑郁老年人进行家庭远程健康问题解决疗法（远程问题解决疗法，tele-PST）的接受度和初步疗效。
共有121名年龄在50岁及以上、在24项汉密尔顿抑郁量表（HAMD）上得分15分及以上的居家个体参与了这项三臂随机对照试验，将远程问题解决疗法与面对面问题解决疗法以及电话支持呼叫进行比较。为问题解决疗法参与者进行了六次问题解决疗法-初级保健疗程。对于远程问题解决疗法，第2至6次疗程通过Skype视频通话进行。使用11项7点量表修改后的治疗评估量表（TEI）来衡量对远程问题解决疗法或面对面问题解决疗法的接受度。采用混合效应回归分析来检验治疗组、时间以及治疗组与时间之间的交互项对HAMD评分的影响。
远程问题解决疗法参与者的TEI评分略高于面对面问题解决疗法参与者。在12周随访时，远程问题解决疗法参与者和面对面问题解决疗法参与者的HAMD评分显著低于电话支持呼叫参与者，并且在24周随访时治疗效果得以维持。远程问题解决疗法参与者的HAMD评分与面对面问题解决疗法参与者的评分没有差异。
尽管最初持怀疑态度，但几乎所有参与者在12周随访时对远程问题解决疗法都持极其积极的态度。远程问题解决疗法似乎也是治疗居家抑郁老年人的一种有效治疗方式，并且在促进他们获得治疗方面具有巨大潜力。
