Engagement and Outcomes Associated With Message-Based Psychotherapy Among Older and Younger Adults

Older adults are underrepresented in digital mental health research. As Medicare expands reimbursement for such services, understanding benefit is paramount. This study examined longitudinal engagement and clinical outcomes among older adults receiving virtual psychotherapy.

Retrospective cohort study of patients who received usual psychotherapy care delivered as asynchronous message-based care and/or live tele-sessions.

Talkspace, a U.S. telemedicine platform.

Talkspace users aged 65+ (n = 510) with elevated depression and/or anxiety symptoms and a randomly selected comparison sample of 510 adults 25-35 with similar depression/anxiety scores.

Cohorts were compared across engagement with the platform and clinical outcomes (change in PHQ-9 [depressive symptoms] or GAD-7 [anxiety symptoms]) over 15 weeks.

Older adults engaged with the digital platform for a shorter duration than younger adults (mean [SD], 16.4 [26.6] versus 24.6 [31.6] weeks; t(989.45) = -4.45, p < 0.001) but did not differ in weekly message frequency, message word count, or video session attendance. Both groups showed significant reductions in depression and anxiety symptoms over 15 weeks. Among participants retained in treatment at week 15, 78.8% of older adults achieved at least the minimally important clinical difference for depression and 64.3% for anxiety, with corresponding rates of 50.0% and 53.7% among younger adults.

Adults aged 65 years and older engaged in digital psychotherapy at levels not significantly different from younger adults. Both older and younger groups experienced substantial reductions in depressive and anxiety symptoms and did not significantly differ in these improvements. Findings support feasibility and clinical utility for older adults.