Many rural veterans struggle to receive treatment for depression due to distance from the nearest VA health facility, difficulty with transportation, or mobility issues. Some veterans avoid mental health treatment because of the stigma associated with such care.
Researchers and clinicians at the Ralph H. Johnson VA Medical Center in Charleston, South Carolina, developed a home-based telepsychology program that tested delivery of behavioral activation therapy to elderly veterans with major depressive disorder. The VA Health Services Research and Development Office funded the four-year study.
Results
A study was conducted in South Carolina from April 2007 to July 2011, with 241 veterans aged 58 years old or older. Of these 241 veterans:
- 71% are rural residents
- 40% are African American
- 21% have an income less than $15,000
- 70% have a disability
- 67% are dual users of Medicaid and Medicare
One group received telehealth treatment via tablet or analogue videophone (to account for any veterans without broadband internet access), while the other group received face-to-face treatment. Researchers found that:
- There was no significant difference in the two groups’ response to treatment.
- 90% of the telehealth patients saw at least a 50% reduction in symptom severity.
- There were no significant differences in quality of life, patient satisfaction, or treatment credibility.
- Cost trajectories over time for inpatient, outpatient, and pharmacy were not different between the two groups.
Researchers concluded that evidence-based behavioral activation via telehealth is an effective way for elderly veterans to overcome barriers to care and receive psychotherapy in their homes. The use of telehealth did not adversely influence patients’ quality of life, satisfaction with care, or cost of care over time, suggesting that home-based telehealth is an effective way to address the mental health needs of rural patients.
Replication
The therapists in the study were masters-level with at least 5 years of clinical experience. They attended a two-day workshop before treating patients using behavioral activation and were overseen by a clinical psychologist.
Patients with the following active or present conditions were excluded from the study and are recommended to seek face-to-face treatment to allow comprehensive treatment of additional symptoms:
- Dementia
- Psychosis
- Suicidal ideation and clear intent
- Substance dependence
To assess patients’ depression, researchers used the Beck Depression Inventory (BDI) and Geriatric Depression Scale (GDS), in addition to the Structured Clinical Interview for DSM-IV.
The researchers have completed another study investigating PTSD and found similar results suggesting telehealth is an effective way to provide mental health treatment. The researchers hope to see additional studies on the effectiveness of telepsychology, especially using other forms of technology such as cell phones.
Population of Focus: Veterans
Additional Resources
- Learn more about Telepsychology-Service Delivery for Depressed Veterans
- Read an article on veteran and military mental health issues
- Check out a study on depression and anxiety rates among older veterans
- Get more information about VA services for veterans
- Read an infographic about provider perspectives on treating PTSD and depression
Date: 2024
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