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Layperson-Supported, Web-Delivered Cognitive Behavioral Therapy for Depression in Older Adults: Randomized Controlled Trial.

作者信息

Xiang Xiaoling, Kayser Jay, Turner Skyla, Ash Samson, Himle Joseph A

机构信息

School of Social Work, University of Michigan, Ann Arbor, MI, United States.

出版信息

J Med Internet Res. 2024 Mar 4;26:e53001. doi: 10.2196/53001.


DOI:10.2196/53001
PMID:38437013
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10949125/
Abstract

BACKGROUND: Depression is the most prevalent mental health condition in older adults. However, not all evidence-based treatments are easily accessible. Web-delivered cognitive behavioral therapy (wCBT) facilitated by laypersons is a viable treatment alternative. OBJECTIVE: This randomized controlled trial aims to evaluate the efficacy of a novel wCBT program, Empower@Home, supported by trained lay coaches, against a waitlist attention control. Empower@Home is among the very few existing wCBT programs specifically designed for older adults. The primary objective was to assess the efficacy of the intervention compared with attention control. The secondary objective was to evaluate the program's impact on secondary psychosocial outcomes and explore potential change mechanisms. METHODS: Older adults (N=70) were recruited via web-based research registries, social media advertisements, and community agency referrals and randomly assigned to either the intervention or control group in a 1:1 allocation ratio. The intervention group received access to Empower@Home, which included 9 web-delivered self-help lessons and weekly telephone coaching sessions by a trained layperson over 10 weeks. The control group received weekly friendly phone calls and depressive symptom monitoring. The primary clinical outcome was the severity of depressive symptoms assessed using the Patient Health Questionnaire-9. The secondary clinical outcomes included anxiety, anger, social isolation, insomnia, pain intensity, and quality of life. Linear mixed modeling was used to determine the treatment effects on depression, and 2-tailed t tests were used to assess within-group changes and between-group differences. RESULTS: Most participants in the intervention group completed all 9 sessions (31/35, 89%). The usability and acceptability ratings were excellent. The intervention group had a large within-group change in depressive symptoms (Cohen d=1.22; P<.001), whereas the attention control group experienced a medium change (Cohen d=0.57; P<.001). The between-group effect size was significant, favoring the intervention group over the control group (Cohen d=0.72; P<.001). In the linear mixed model, the group-by-time interaction was statistically significant (b=-0.68, 95% CI -1.00 to -0.35; P<.001). The treatment effects were mediated by improvements in cognitive behavioral therapy skills acquisition; behavioral activation; and satisfaction with the basic psychological needs of autonomy, competence, and relatedness. Furthermore, the intervention group showed significant within-group improvements in secondary psychosocial outcomes, including anxiety (P=.001), anger (P<.001), social isolation (P=.02), insomnia (P=.007), and pain (P=.03). By contrast, the control group did not experience significant changes in these outcome domains. However, the between-group differences in secondary outcomes were not statistically significant, owing to the small sample size. CONCLUSIONS: Empower@Home, a wCBT program supported by lay coaches, was more efficacious in reducing depressive symptoms than friendly telephone calls and depression symptom monitoring. Future studies should examine the effectiveness of the intervention in community and practice settings using nonclinician staff already present in these real-world settings as coaches. TRIAL REGISTRATION: ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/44210.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb42/10949125/c093bacf3411/jmir_v26i1e53001_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb42/10949125/c093bacf3411/jmir_v26i1e53001_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb42/10949125/c093bacf3411/jmir_v26i1e53001_fig1.jpg

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本文引用的文献

[1]
Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study.

JMIR Aging. 2023-9-19

[2]
Layperson-Facilitated Internet-Delivered Cognitive Behavioral Therapy for Homebound Older Adults With Depression: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc. 2023-2-22

[3]
Entertain Me Well: An Entertaining, Tailorable, Online Platform Delivering CBT for Depression.

Cogn Behav Pract. 2023-2

[4]
Prevalence and determinants of depression among old age: a systematic review and meta-analysis.

Ann Gen Psychiatry. 2021-12-18

[5]
Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants' Experiences.

JMIR Aging. 2021-11-22

[6]
Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis.

Front Digit Health. 2021-11-4

[7]
Sample size determination and power analysis using the G*Power software.

J Educ Eval Health Prof. 2021

[8]
Effect of Layperson-Delivered, Empathy-Focused Program of Telephone Calls on Loneliness, Depression, and Anxiety Among Adults During the COVID-19 Pandemic: A Randomized Clinical Trial.

JAMA Psychiatry. 2021-6-1

[9]
Effect of Telehealth Treatment by Lay Counselors vs by Clinicians on Depressive Symptoms Among Older Adults Who Are Homebound: A Randomized Clinical Trial.

JAMA Netw Open. 2020-8-3

[10]
United States Valuation of EQ-5D-5L Health States Using an International Protocol.

Value Health. 2019-5-25

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