Efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults: a systematic review

Abstract

Background: Older adults experience symptoms of depression, leading to suffering and increased morbidity and mortality. Although we have effective depression therapies, physical distancing and other public health measures have severely limited access to in-person interventions. Objective: To describe the efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults. Design: Systematic review. Setting: We searched MEDLINE, EMBASE, Cochrane Libraries, PsycINFO, and gray literature from inception to July 5, 2021. Participants and interventions: We included randomized trials (RCTs) comparing the efficacy of virtual interventions to any other virtual intervention or usual care in community-dwelling adults ≥60 years old experiencing symptoms of depression or depression as an outcome. Measurements: The primary outcome was change in symptoms of depression measured by any depression scale. Results: We screened 12,290 abstracts and 830 full text papers. We included 15 RCTs (3100 participants). Five RCTs examined persons with depression symptoms at baseline and ten examined depression as an outcome only. Included studies demonstrated feasibility of interventions such as internet or telephone cognitive behavioral therapy with some papers showing statistically significant improvement in depressive symptoms. Conclusions: There is a paucity of studies examining virtual interventions in older adults with depression. Given difficulty in accessing in-person therapies in a pandemic and poor access for people living in rural and remote regions, there is an urgent need to explore efficacy, effectiveness, and implementation of virtual therapies.

Can we bridge the digital divide to improve the mental health of older adults?

“…The participants were mostly in the "younger" age groups (mean ages varied between 65.1 years and 79.2 years). Overall, the review findings were that virtual interventions, including the use telephones, for depressive symptoms in community-dwelling older adults appeared to be feasible with some studies demonstrating efficacy, and importantly, no studies demonstrating harm (Goodarzi et al, 2022).…”

“…All of this backdrop demonstrates the importance of the review by Goodarzi and colleagues (Goodarzi et al, 2022). This systematic review examined the efficacy of virtual interventions for reducing depressive symptoms in community-dwelling older adults.…”

“…The review authors conducted a very thorough search that included gray literature and undertook this with clearly articulated rigorous methodology. It was promising to see that 15 randomized controlled trials met inclusion criteria with five that included participants with depressive symptoms or disorders at baseline and ten that examined depression as an outcome (Goodarzi et al, 2022). The studies were mainly undertaken in the USA and Australia, both high-income countries with highly available virtual technologies, and investigated quite a variety of interventions with different levels of health-care provider involvement (Goodarzi et al, 2022).…”

“…It was promising to see that 15 randomized controlled trials met inclusion criteria with five that included participants with depressive symptoms or disorders at baseline and ten that examined depression as an outcome (Goodarzi et al, 2022). The studies were mainly undertaken in the USA and Australia, both high-income countries with highly available virtual technologies, and investigated quite a variety of interventions with different levels of health-care provider involvement (Goodarzi et al, 2022). The participants were mostly in the "younger" age groups (mean ages varied between 65.1 years and 79.2 years).…”

“…For example, our research showed a new mode of delivery (online) of cognitive behavioral therapy for weight loss to be useful and acceptable to adults across a range of ages, including participants over the age of 60 years (Tham and Chong, 2020). Goodarzi et al (2022) have in Table 2 specified such modes of delivery and established examples for other researchers in future explorations to add to the evidence base. Keeping in mind the digital divide, the simple and more basic technology, the landline telephone, should not be sidelined for the more sophisticated applications which may not be accessible to considerable numbers of the community-dwelling older adult population.…”