Feasibility of Telehealth Problem-Solving Therapy for Depressed Homebound Older Adults

Older people with disabilities who cannot leave their homes are at increased risk of
depression or depressive symptoms. Short-term psychotherapy, without medications, has been
found effective for treating this population of people. Problem-solving therapy (PST) is a
brief, structured, cognitive-behavioral therapy that teaches people problem-solving and
coping skills to deal with negative life events and daily problems. Previous research
demonstrated that PST is an effective treatment for depression when delivered to older
adults in their homes. The cost of service for these in-home visits, however, can be
prohibitive for many older adults and social service providers. One way to extend treatment
to more older adults is to deliver PST via teleconferencing (tele-PST). This study will test
the feasibility and effectiveness of tele-PST in treating depression in homebound older
adults.

This study will have two phases. Phase 1 will examine the feasibility of delivering
treatment via teleconference. Participants in this phase will receive six weekly sessions of
tele-PST and then complete a 2-week follow-up visit in which their depression, disability,
and resourcefulness will be assessed. Logistical and procedural problems and acceptability
of the treatment to participants will be used to guide modifications or adaptations made to
tele-PST before conducting a larger, randomized trial in Phase 2.

Participation in Phase 2 will last 6 weeks, with follow-up visits lasting until 24 weeks
after the conclusion of treatment. Participants will be randomly assigned to one of three
groups: tele-PST, in-person PST, and attention control. Participants in the tele-PST group
will receive six weekly sessions of PST via teleconference, and participants in the
in-person PST group will receive six weekly sessions of PST from a study therapist in
person. Both these groups will also receive six monthly maintenance calls from their study
therapist after the completion of treatment. Participants in the attention group will
receive six weekly phone calls followed by six monthly phone calls to monitor their health.
All participants in Phase 2 will complete assessments at 2, 12, and 24 weeks following their
treatment. These assessments will measure the adequacy of recruitment, enrollment, and
retention strategies; the compliance rates and service delivery costs of tele-PST and
in-person PST; and participants' depression, disability, and resourcefulness.