Layperson-Supported, Web-Delivered Cognitive Behavioral Therapy for Depression in Older Adults: Randomized Controlled...

Area of Science:

• Gerontology
• Mental Health
• Digital Health

Background:

• Depression is a leading mental health concern among older adults.
• Access to evidence-based treatments can be a significant barrier for this population.
• Web-delivered cognitive behavioral therapy (wCBT) offers a potential solution, particularly when facilitated by laypersons.

Purpose of the Study:

• To evaluate the efficacy of Empower@Home, a novel wCBT program for older adults, against a waitlist attention control.
• To assess the program's impact on secondary psychosocial outcomes.
• To explore potential change mechanisms underlying the intervention's effects.

Main Methods:

• A randomized controlled trial involving 70 older adults.
• Intervention group received 9 web-delivered lessons and 10 weeks of lay coach telephone support.
• Control group received weekly friendly phone calls and symptom monitoring.
• Primary outcome: depressive symptom severity (Patient Health Questionnaire-9).

Main Results:

• The Empower@Home intervention group showed a large significant reduction in depressive symptoms (Cohen d=1.22, P<.001).
• Between-group analysis revealed a significant effect favoring the intervention (Cohen d=0.72, P<.001).
• Improvements in CBT skills, behavioral activation, and psychological needs satisfaction mediated treatment effects.

Conclusions:

• Empower@Home, a lay-coach-supported wCBT program, is more effective than attention control in reducing depressive symptoms in older adults.
• The program demonstrated significant within-group improvements in anxiety, anger, social isolation, insomnia, and pain.
• Future research should explore the effectiveness of using non-clinician staff as coaches in community settings.