Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences

Xiang, Xiaoling; Kayser, Jay; Sun, Yihang; Himle, Joseph A.

doi:10.2196/27630

Cited by 15 publications

(42 citation statements)

References 30 publications

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“…Following technological progress, modern digital health interventions have become mainstream in medical and healthcare services. During the COVID-19 pandemic, the conventional medical and healthcare service mode (hospital outpatient service and routine healthcare projects) has been "devastating, " whereas modern digital health intervention technologies have developed rapidly (Table 2 and Figure 1) (117)(118)(119)(120)(121)(122).…”

Section: Digit-based Treatment Of Lldmentioning

confidence: 99%

“…Internet-based cognitive behavioral therapy (iCBT) has also been used to treat patients with LLD (122). The potential efficacy and cost-effectiveness of iCBT in the treatment of LLD were examined in randomized interventions with telephone-delivered CBT or telephone-delivered non-directive supportive therapy (NST) for patients with LLD.…”

Section: Digit-based Treatment Of Lldmentioning

confidence: 99%

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Late-life depression: Epidemiology, phenotype, pathogenesis and treatment before and during the COVID-19 pandemic

Zhao

Tang³

et al. 2023

Front. Psychiatry

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Late-life depression (LLD) is one of the most common mental disorders among the older adults. Population aging, social stress, and the COVID-19 pandemic have significantly affected the emotional health of older adults, resulting in a worldwide prevalence of LLD. The clinical phenotypes between LLD and adult depression differ in terms of symptoms, comorbid physical diseases, and coexisting cognitive impairments. Many pathological factors such as the imbalance of neurotransmitters, a decrease in neurotrophic factors, an increase in β-amyloid production, dysregulation of the hypothalamic-pituitary-adrenal axis, and changes in the gut microbiota, are allegedly associated with the onset of LLD. However, the exact pathogenic mechanism underlying LLD remains unclear. Traditional selective serotonin reuptake inhibitor therapy results in poor responsiveness and side effects during LLD treatment. Neuromodulation therapies and complementary and integrative therapies have been proven safe and effective for the treatment of LLD. Importantly, during the COVID-19 pandemic, modern digital health intervention technologies, including socially assistive robots and app-based interventions, have proven to be advantageous in providing personal services to patients with LLD.

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Section: Digit-based Treatment Of Lldmentioning

confidence: 99%

Section: Digit-based Treatment Of Lldmentioning

confidence: 99%

Late-life depression: Epidemiology, phenotype, pathogenesis and treatment before and during the COVID-19 pandemic

Zhao

Tang³

et al. 2023

Front. Psychiatry

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“…The review comprised 17 research studies. 35 – 51 Of the papers, nine were qualitative studies, and eight were mixed-method studies with an analysis of qualitative data. The sample size ranged from 2 to 90.…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to acceptance and implementation of eMental-health intervention among older adults: A qualitative systematic review

Peng,

Li,

Guo

et al. 2024

DIGITAL HEALTH

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Objective Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults. Methods We comprehensively retrieved six electronic databases from January 2012 to September 2022: PubMed, Web of Science, Embase, Scopus, PsycINFO, and CINAHL. The JBI-QARI was used to assess the quality of the research methodology of each publication. Eligible studies underwent data coding and synthesis aligned to inductive and deductive methods. The Consolidated Framework for Implementation Research 2.0 was used as a deductive framework to guide a more structured analysis. Results The systematic review screened 4309 articles, 17 of which were included (eight with mixed methods and nine with qualitative methods). We identified and extracted the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults: (1) innovation: technology challenges, optimized functions, and contents, security and privacy; (2) outer setting: community engagement and partnerships, financing; (3) inner setting: leadership engagement, available resources, incompatibility, intergenerational support, training and guidance; (4) individuals: perceptions, capability, motivation of older adults and healthcare providers; and (5) implementation process: recruit, external assistance, and team. Conclusion These findings are critical to optimizing, promoting, and expanding electronic mental health interventions among older adults. The systematic review also provides a reference for better evidence-based implementation strategies in the future.

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“…Recent studies involving homebound older adults have shown that modifications to both contents (eg, adding aging-related themes) and web interface (website or app) are needed to improve adherence and engagement with iCBT [33,34]. These studies suggest that older adults had difficulty applying lessons when presented with content that failed to address aging-related topics and were less tolerant to poor usability issues, possibly due to a combination of age-related changes (eg, cognitive, vision, motor control, speech, and hearing), physical disabilities, and their lack of familiarity with modern technology.…”

Section: Althoughmentioning

confidence: 99%

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

Kayser¹,

Wang²,

Wu³

et al. 2023

JMIR Res Protoc

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Background Depression in older adults has serious biological, psychological, and social consequences. Homebound older adults experience a high burden of depression and significant barriers to accessing mental health treatments. Few interventions to address their specific needs have been developed. Existing treatment modalities can be challenging to scale up, are not tailored to unique population concerns, and require significant staffing support. Technology-assisted, layperson-facilitated psychotherapy has the potential to overcome these challenges. Objective The aim of this study is to assess the efficacy of a layperson-facilitated internet-delivered cognitive behavioral therapy program tailored for homebound older adults. The novel intervention, Empower@Home, was developed based on user-centered design principles and partnerships between researchers, social service agencies, care recipients, and other stakeholders serving low-income homebound older adults. Methods This 2-arm, 20-week pilot randomized controlled trial (RCT) with a waitlist control crossover design aims to enroll 70 community-dwelling older adults with elevated depressive symptoms. The treatment group will receive the 10-week intervention immediately, whereas the waitlist control group will cross over and receive the intervention after 10 weeks. This pilot is part of a multiphase project involving a single-group feasibility study (completed in December 2022). This project consists of a pilot RCT (described in this protocol) and an implementation feasibility study running in parallel with the pilot RCT. The primary clinical outcome of the pilot is the change in depressive symptoms after the intervention and at the 20-week postrandomization follow-up. Additional outcomes include acceptability, adherence, and changes in anxiety, social isolation, and quality of life. Results Institutional review board approval was obtained for the proposed trial in April 2022. Recruitment for the pilot RCT began in January 2023 and is anticipated to end in September 2023. On completion of the pilot trial, we will examine the preliminary efficacy of the intervention on depression symptoms and other secondary clinical outcomes in an intention-to-treat analysis. Conclusions Although web-based cognitive behavioral therapy programs are available, most programs have low adherence and very few are tailored for older adults. Our intervention addresses this gap. Older adults, particularly those with mobility difficulties and multiple chronic health conditions, could benefit from internet-based psychotherapy. This approach can serve a pressing need in society while being cost-effective, scalable, and convenient. This pilot RCT builds on a completed single-group feasibility study by determining the preliminary effects of the intervention compared with a control condition. The findings will provide a foundation for a future fully-powered randomized controlled efficacy trial. If our intervention is found to be effective, implications extend to other digital mental health interventions and populations with physical disabilities and access restrictions who face persistent disparities in mental health. Trial Registration ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276 International Registered Report Identifier (IRRID) PRR1-10.2196/44210

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Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences

Cited by 15 publications

References 30 publications

Late-life depression: Epidemiology, phenotype, pathogenesis and treatment before and during the COVID-19 pandemic

Late-life depression: Epidemiology, phenotype, pathogenesis and treatment before and during the COVID-19 pandemic

Barriers and facilitators to acceptance and implementation of eMental-health intervention among older adults: A qualitative systematic review

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

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