BACKGROUND
Depression is the most prevalent mental health condition among older adults. While evidence-supported treatments are available, not all are easily accessible. Web-delivered cognitive-behavioral therapy (wCBT) facilitated by laypersons presents a viable treatment alternative.
OBJECTIVE
This study evaluates the efficacy of a novel wCBT program, Empower@Home, supported by trained lay coaches, against a waitlist attention control in a randomized controlled trial. Empower@Home is among the very few existing wCBT programs designed specifically for older adults. The primary objective assesses the efficacy of the intervention compared to attention control. The secondary objective evaluates the program’s impact on secondary psychosocial outcomes and explores potential change mechanisms.
METHODS
Older adults (N = 70) were randomly assigned to either the intervention or control group following a 1:1 allocation ratio. The intervention group received access to Empower@Home, which included 9 web-delivered self-help lessons and weekly telephone coaching sessions by a layperson over 10 weeks. The control group received weekly friendly phone calls and depressive symptoms monitoring. The primary clinical outcome was the severity of depressive symptoms assessed using the Patient Health Questionnaire (PHQ-9). Secondary clinical outcomes included anxiety, anger, social isolation, insomnia, pain intensity, and quality of life. Linear mixed modeling was used to determine the treatment effects on depression, and t-tests were used to assess within-group changes and between-group differences.
RESULTS
Most participants in the intervention group completed all 9 sessions (n = 31, 89%). Usability and acceptability ratings were excellent. The intervention group had a large within-group change in depressive symptoms (Cohen’s d = 1.22, p < .001), whereas the attention control group experienced a medium change (Cohen’s d = .57, p < .001). The between-group effect size was significant, favoring the intervention over the control (Cohen’s d = .72, p < .001). In the linear mixed model, group-by-time interaction was statistically significant (b = -.68, 95% CI [ -1.00, -.35], p < .001). The treatment effects were mediated by improvements in CBT skills acquisition, behavioral activation, and satisfaction with the basic psychological needs of autonomy, competence, and relatedness. Furthermore, the intervention group had significant within-group improvements in secondary psychosocial outcomes, including anxiety, anger, social isolation, insomnia, and pain. In contrast, the control group did not experience significant changes in these outcome domains. However, the between-group differences in secondary outcomes were not statistically significant due to the small sample size.
CONCLUSIONS
Empower@Home, a wCBT program supported by lay coaches, was more efficacious in reducing depressive symptoms than friendly telephone calls and depression symptom monitoring. Future studies should examine the effectiveness of the intervention in community and practice settings, utilizing non-clinician staff already present in these real-world settings as coaches.
CLINICALTRIAL
ClinicalTrials.gov. NCT05593276. Registered on 24 October 2022. https://clinicaltrials.gov/ct2/show/NCT05593276
INTERNATIONAL REGISTERED REPORT
RR2-10.2196/44210