Choi Namkee G, Marti C Nathan, Bruce Martha L, Hegel Mark T, Wilson Nancy L, Kunik Mark E
The University of Texas at Austin, Austin, Texas.
Depress Anxiety. 2014 Aug;31(8):653-61. doi: 10.1002/da.22242. Epub 2014 Feb 5.
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.
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.
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.
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.
尽管居家老年人抑郁症发病率很高，但他们获得循证心理治疗的机会有限。本文旨在报告针对低收入居家老年人在干预后6个月内通过远程健康问题解决疗法（通过Skype视频通话进行远程PST）所取得的抑郁和残疾状况改善结果。
一项三臂随机对照试验比较了远程PST与面对面PST以及电话关怀呼叫对158名居家个体的疗效，这些个体年龄在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。使用随机截距模型的混合效应回归分析治疗对抑郁严重程度（HAMD评分）和残疾（世界卫生组织残疾评估量表[WHODAS]评分）的影响。使用平行过程潜在增长曲线模型检查抑郁与残疾之间可能的相互关系。
远程PST和面对面PST对低收入居家老年人都是有效的治疗方法；然而，远程PST对抑郁和残疾状况改善结果的影响持续时间明显长于面对面PST。在36周时，HAMD评分变化的效应量（dGMA-原始值），远程PST为0.68，面对面PST为0.20。在36周时，WHODAS评分变化的效应量，远程PST为0.47，面对面PST为0.25。结果还支持抑郁与残疾状况改善结果之间的相互和间接影响。
远程心理治疗的有效性和潜在低成本表明，它有可能易于复制和持续开展，从而惠及大量未得到充分服务的老年人，并改善他们获得心理健康服务的机会。
