The reciprocal relationship between depression and disability in low‐income homebound older adults following tele‐depression treatment

Abstract

Objectives Research has shown ample evidence for reciprocity between depression and disability. We examined whether decreases in disability among low‐income, homebound older adults who received brief depression treatments were mediated by improvement in depressive symptoms and vice versa and whether the mediation effects varied by treatment modality. Methods In a 3‐arm randomized clinical trial, 277 low‐income homebound individuals aged 50+ participated in behavioral activation tele‐delivered by bachelor's‐level lay counselors (Tele‐BA), problem‐solving therapy tele‐delivered by licensed clinicians (Tele‐PST), or telephone support calls (attention control). Depressive symptoms were assessed with the 24‐item Hamilton Rating Scale for Depression and disability with the 12‐item World Health Organization Disability Schedule 2.0. Along with mediation models, mediation was assessed controlling for autoregressive and contemporaneous effects. Results Mediation models showed evidence of postintervention disability and depression mediating each other in separate mediation models. In the cross‐lagged model, in which autoregressive and contemporaneous effects were included, only the depression‐to‐disability path exhibited mediation. There was no evidence of difference between Tele‐BA and Tele‐PST. Although the temporal precedence of treatment conditions on the outcomes is apparent, we could not establish a temporal precedence between disability and depression as these two measures exhibited parallel improvement. Conclusions Brief depression treatments for low‐income homebound older adults were effective in reducing both depression and disability among these disabled older adults. The importance of this study lies in the comparable effects of Tele‐BA and Tele‐PST. Lay‐counselor model is a promising alternative to clinician‐delivered psychotherapy for growing numbers of homebound older adults.

Depression in persons with disabilities: a scoping review

“…As shown by Table 3 , all patients included in the multiple sclerosis study by Jaalkhorol et al ( 56 ), work disability report by Sullivan et al ( 65 ), developmental disability evaluation by McDermott et al ( 66 ), learning disability determination by Ugwu et al ( 60 ), functional disability report by Lutz et al ( 45 ), general disability by Marti et al ( 46 ), and physical disability determination by Zemestani et al ( 67 ), had depression measured by different measuring instruments including PHQ-9, CDI, HAMD, and BDI in several parts of the world, namely, Mongolia, Canada, Spain, Nigeria, United States, and Iran.…”

Use of Telehealth to Address Depression and Anxiety in Low-income US Populations: A Narrative Review

“…To alleviate this barrier, virtual therapy was provided by social workers or lay counselors. 14 , 20 Traditional mental health providers were psychiatrists and licensed clinicians for conducting virtual therapy through video or telephone. An emphasis on telephone interactions was noted in many of the studies.…”

“…Virtual therapy was the most commonly used telehealth intervention, [14][15][16][17][18][19][20] and it included psychotherapy, cognitive behavioral therapy (CBT), and post behavioral activation (BA) therapy. The second most referenced telehealth intervention was virtual patient monitoring and self-management tools.…”

Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression

“…There is very little research on efficacy of telemental health with lower income individuals. Studies of depression treatments conducted with lower income, homebound older adults, have demonstrated efficacy in reducing both depression and disability among disabled older adults ( 35 – 37 ), though these studies did not compare lower with higher income individuals. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities.…”