Abstract:
BACKGROUND:Many older adults with major depression, particularly veterans, do not have access to evidence-based psychotherapy. Telemedicine could increase access to best-practice care for older adults facing barriers of mobility, stigma, and geographical isolation. We aimed to establish non-inferiority of behavioural activation therapy for major depression delivered via telemedicine to same-room care in largely male, older adult veterans. METHODS:In this randomised, controlled, open-label, non-inferiority trial, we recruited veterans (aged ≥58 years) meeting DSM-IV criteria for major depressive disorder from the Ralph H Johnson Veterans Affairs Medical Center and four associated community outpatient-based clinics in the USA. We excluded actively psychotic or demented people, those with both suicidal ideation and clear intent, and those with substance dependence. The study coordinator randomly assigned participants (1:1; block size 2-6; stratified by race; computer-generated randomisation sequence by RGK) to eight sessions of behavioural activation for depression either via telemedicine or in the same room. The primary outcome was treatment response according to the Geriatric Depression Scale (GDS) and Beck Depression Inventory (BDI; defined as a 50% reduction in symptoms from baseline at 12 months), and Structured Clinical Interview for DSM-IV, clinician version (defined as no longer being diagnosed with major depressive disorder at 12 months follow-up), in the per-protocol population (those who completed at least four treatment sessions and for whom all outcome measurements were done). Those assessing outcomes were masked. The non-inferiority margin was 15%. This trial is registered with ClinicalTrials.gov, number NCT00324701. FINDINGS:Between April 1, 2007, and July 31, 2011, we screened 780 patients, and the study coordinator randomly assigned participants to either telemedicine (120 [50%]) or same-room treatment (121 [50%]). We included 100 (83%) patients in the per-protocol analysis in the telemedicine group and 104 (86%) in the same-room group. Treatment response according to GDS did not differ significantly between the telemedicine (22 [22·45%, 90% CI 15·52-29·38] patients) and same-room (21 [20·39%, 90% CI 13·86-26·92]) groups, with an absolute difference of 2·06% (90% CI -7·46 to 11·58). Response according to BDI also did not differ significantly (telemedicine 19 [24·05%, 90% CI 16·14-31·96] patients; same room 19 [23·17%, 90% CI 15·51-30·83]), with an absolute difference of 0·88% (90% CI -10·13 to 11·89). Response on the Structured Clinical Interview for DSM-IV, clinician version, also did not differ significantly (39 [43·33%, 90% CI 34·74-51·93] patients in the telemedicine group and 46 [48·42%, 90% CI 39·99-56·85] in the same-room group), with a difference of -5·09% (-17·13 to 6·95; p=0·487). Results from the intention-to-treat population were similar. MEM analyses showed that no significant differences existed between treatment trajectories over time for BDI and GDS. The criteria for non-inferiority were met. We did not note any adverse events. INTERPRETATION:Telemedicine-delivered psychotherapy for older adults with major depression is not inferior to same-room treatment. This finding shows that evidence-based psychotherapy can be delivered, without modification, via home-based telemedicine, and that this method can be used to overcome barriers to care associated with distance from and difficulty with attendance at in-person sessions in older adults. FUNDING:US Department of Veterans Affairs.
journal_name
Lancet Psychiatryjournal_title
The lancet. Psychiatryauthors
Egede LE,Acierno R,Knapp RG,Lejuez C,Hernandez-Tejada M,Payne EH,Frueh BCdoi
10.1016/S2215-0366(15)00122-4subject
Has Abstractpub_date
2015-08-01 00:00:00pages
693-701issue
8eissn
2215-0366issn
2215-0374pii
S2215-0366(15)00122-4journal_volume
2pub_type
杂志文章,随机对照试验abstract:BACKGROUND:In high-income countries, maternal postnatal depression is associated with adverse outcomes in the child. However, few studies have investigated this relation in countries of low and middle income. Furthermore, to our knowledge, no studies have followed up cohorts into later childhood. We aimed to investigat...
journal_title:The lancet. Psychiatry
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journal_title:The lancet. Psychiatry
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,meta分析
doi:10.1016/S2215-0366(18)30269-4
更新日期:2018-09-01 00:00:00
abstract::Over the past decade, concussion has become the most widely discussed injury in contact sports. However, concussions also occur in several other settings, such as non-contact sports, elderly individuals, young children, military personnel, and victims of domestic violence. Concussion is frequently undiagnosed as a cau...
journal_title:The lancet. Psychiatry
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更新日期:2016-12-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,随机对照试验
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journal_title:The lancet. Psychiatry
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(14)70247-0
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:People living in group situations or with dementia are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older people and those with multimorbidity have higher mortality if they become infected than the general population. However, no systematic study exists of C...
journal_title:The lancet. Psychiatry
pub_type: 杂志文章
doi:10.1016/S2215-0366(20)30434-X
更新日期:2020-12-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,meta分析,评审
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更新日期:2015-10-01 00:00:00
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更新日期:2018-09-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章
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更新日期:2018-04-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,评审
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更新日期:2016-09-01 00:00:00
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journal_title:The lancet. Psychiatry
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更新日期:2017-07-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2215-0366(14)00069-8
更新日期:2015-02-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,随机对照试验
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更新日期:2018-08-01 00:00:00
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journal_title:The lancet. Psychiatry
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2019-04-01 00:00:00