Psychotherapy for depression in older veterans via telemedicine: a randomised, open-label, non-inferiority trial

Egede, Leonard E.; Acierno, Ron; Knapp, Rebecca G.; Lejuez, Carl W.; Hernandez‐Tejada, Melba A.; Payne, Elizabeth H.; Frueh, B. Christopher

doi:10.1016/s2215-0366(15)00122-4

Cited by 169 publications

(147 citation statements)

References 39 publications

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“…Studies that have compared telemedicine with face-to-face delivery of PTSD treatment in veteran samples have consistently found that telemedicine and as face-to-face care are equally effective (Acierno et al, in press; Egede et al, 2015; Maieritsch et al, 2015; Morland et al, 2015; Yuen et al, 2015). Previous studies have compared telemedicine to in-person modalities for the treatment of PTSD using cognitive processing therapy with Iraq/Afghanistan veterans (Maieritsch et al, 2015), cognitive processing therapy with female veterans (Morland et al, 2015), and PE among veterans in RCTs (Yuen et al, 2015) and in effectiveness settings (Gross et al, 2011; Tuerk et al, 2010).…”

Section: Methodsmentioning

confidence: 99%

“…PTSD treatment via standard telemedicine (i.e., central hub clinic to distal satellite clinic) and HBT have thus far been found to be non-inferior to the same treatment delivered in-person (Acierno et al, in press; Egede et al, 2015; Maieritsch, et al, 2015; Morland, et al, 2015); and to yield comparable dropout rates for veterans (Hernandez-Tejada, Zoller, Ruggiero, Kazley, & Acierno, 2014). HBT is thus a promising mode of PTSD service delivery to female veterans with MST that allows for enhanced treatment access.…”

Section: Introductionmentioning

confidence: 99%

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“Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?”: Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals

Gilmore

Davis

Grubaugh

et al. 2016

Contemporary Clinical Trials

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Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because ‘dose received’, that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?”: Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals

Gilmore

Davis

Grubaugh

et al. 2016

Contemporary Clinical Trials

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, as patients must travel to satellite clinics, stigma and logistic barriers are still present in hub and spoke telehealth models. By contrast, home-based telehealth (HBT)-delivered psychotherapy may address these barriers to a higher degree, and initial work by our group demonstrates encouraging results (Acierno et al, 2016; Egede et al, 2015). …”

Section: Barriers To Seeking Treatment and A Potential Solution: Homementioning

confidence: 96%

A non-inferiority trial of Prolonged Exposure for posttraumatic stress disorder: In person versus home-based telehealth

Acierno

Knapp

Tuerk

et al. 2017

Behaviour Research and Therapy

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174

128

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This is the first randomized controlled trial to evaluate non-inferiority of Prolonged Exposure (PE) delivered via home-based telehealth (HBT) compared to standard in-person (IP) PE. One-hundred thirty two Veterans recruited from a Southeastern Veterans Affairs Medical Center and affiliated University who met criteria for posttraumatic stress disorder (PTSD) were randomized to receive PE via HBT or PE via IP. Results indicated that PE-HBT was non-inferior to PE-IP in terms of reducing PTSD scores at post-treatment, 3 and 6 month follow-up. However, non-inferiority hypotheses for depression were only supported at 6 month follow-up. HBT has great potential to reduce patient burden associated with receiving treatment in terms of travel time, travel cost, lost work, and stigma without sacrificing efficacy. These findings indicate that telehealth treatment delivered directly into patients’ homes may dramatically increase the reach of this evidence-based therapy for PTSD without diminishing effectiveness.

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“…However, the latter study focused on a “young old” population (50 to 64 years old). As reviewed herein, recent work by Egede and colleagues(27) has supported the noninferiority of telemedicine using BA for LLD. Related to the growing interest in internet-based treatment delivery, there is a growing interest in novel use of mobile technology for depression treatment, such as mental health apps for smartphones.…”

Section: Emerging Treatments and Future Directionsmentioning

confidence: 74%

“…Therefore, targeting engagement in rewarding and purposeful activities is pertinent to these very transitions older adults are navigating. There is recent meta-analytic support for BA for depression in adults(26); however, few studies have implemented BA among older adults with major depressive disorder, Recently, Egede et al(27) conducted an open non-inferiority trial of telemedicine and in-person BA for older Veterans meeting diagnostic criteria for MDD. Both treatment modalities resulted in large, meaningful effects in depression symptom reduction and remission, and telemedicine was judged not inferior to in-person treatment.…”

Section: Psychosocial Treatmentsmentioning

confidence: 99%

Psychosocial Treatment Options for Major Depressive Disorder in Older Adults

Renn

Areán

2017

Curr Treat Options Psych

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Opinion Statement Late-life depression (LLD) is a public health concern with deleterious effects on overall health, cognition, quality of life, and mortality. Although LLD is relatively common, it is not a normal part of aging and is often under-recognized in older adults. However, psychotherapy is an effective treatment for LLD that aligns with many patients’ preferences and can improve health and functioning. This review synthesized the current literature on evidence-based psychotherapies for the treatment of depression in older adults. Findings suggest that active, skills-based psychotherapies (cognitive behavioral therapy [CBT] and problem-solving therapy [PST]) may be more effective for LLD than non-directive, supportive counseling. PST may be particularly relevant for offsetting skill deficit associated with LLD, such as in instances of cognitive impairment (especially executive dysfunction) and disability. Emerging treatments also consider contextual factors to improve treatment delivery, such as personalized care, access, and poverty. Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults. Although these strategies hold promise, further investigation via randomized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD. Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence-based psychosocial interventions for LLD.

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Psychotherapy for depression in older veterans via telemedicine: a randomised, open-label, non-inferiority trial

Cited by 169 publications

References 39 publications

“Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?”: Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals

“Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?”: Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals

A non-inferiority trial of Prolonged Exposure for posttraumatic stress disorder: In person versus home-based telehealth

Psychosocial Treatment Options for Major Depressive Disorder in Older Adults

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