Elderly succeed with internet depression treatment

Age is not a barrier to success in treating depression and anxiety online, says a leading researcher in the field, whose multiple studies have found four in every five participants improve plus older people have higher course completion rates


From the THIS WAY UP clinic’s online program for people with anxiety and depressive disorders

Age is not a barrier to success in treating depression and anxiety online, says a leading researcher in the field, whose multiple studies have found four in every five participants improve plus older people have higher course completion rates.

The Clinical Research Unit for Anxiety and Depression (CRUfAD) at St Vincent’s Hospital, Sydney, has developed a treatment for anxiety and depressive disorders delivered over the web known as internet delivered cognitive behaviour therapy (iCBT).

Among its research CRUfAD has completed 20 randomised controllled trials of iCBT involving 3,500 clinicians and 8,000 patients.

Professor Gavin Andrews, a Professor of Psychiatry at UNSW at St Vincent’s Hospital, Sydney and head of CRUfAD, said the results they were getting were remarkable.

“Every cohort of 500 you take, you get the same result – 80 per cent improve, 60 per cent to the point of being well; 20 per cent don’t improve but the system tells the doctor,” Prof Andrews told AAA.

He said older participants did better than their younger counterparts with the program primarily because they were more committed to completing the program.

“Adherence is better. They improve. Those who complete the course improve equally to the young so age is no barrier. And a long history of difficulties with depression or anxiety are no barrier either.”

Gavin Andrews
Professor Gavin Andrews

Around 5,000 people used their service at the online THIS WAY UP clinic last year, Prof Andrews said.

It is an automated one-size-fits-all and self-paced program that people undertake for anxiety and depressive disorders. It involves six courses presented in a cartoon format.

“Like all computer-aided teaching people learn from what’s on the computer and they use the guide or the expert to clarify things they don’t understand,” Prof Andrews said.

He said while 20 per cent of people did not improve after completing the program, the system included a “fail-safe” feature.

“Unlike Prozac it sends an email to the doctor in charge saying ‘Molly is not doing very well, suggest you schedule an extra appointment’… and it says to Molly ‘you’re a bit more distressed this week than last week you really should schedule an extra meeting with the doctor’.”

He said the availability of the online courses had reduced the waiting list for treatment from up to 12 months to zero and staff now had time to treat in person the hard to get to people.

Older people with chronic disease and depression

CRUfAD is now undertaking four iCBT trials specifically for older people who are depressed plus have either diabetes, heart failure, arthritis or breast cancer.

The impetus for this research is evidence that if you have a chronic physical disease and you are co-morbidly depressed, you will die two years earlier from your physical disease than you needed to, and if someone treats your depression you will live two years longer, Prof Andrews said.

“We don’t have results yet but we know that people are enrolling and doing the courses. I presume that we will enable them to live two years longer.”

He said the other important thing was that being depressed and having a concurrent physical disease was a marker for dementia.

“Not only might we able them to live longer but we will enable them to live without dementing. That’s a big call but it’s interesting. That’s what the literature says.”

Recruitment is ongoing for the diabetes, heart failure and arthritis studies and volunteers are welcome. The breast cancer trial is yet to begin. Information is available at the clinic’s research site, Virtual Clinic.

Strategies for dementia carers

Elsewhere, the clinical research unit is developing a program for carers of people with dementia with a grant from NMHRC and Alzheimer’s Australia.

The first course they developed was about what to do when the person with dementia keeps asking the same question over and over, Prof Andrews said.

“Carers need these strategies so the notion is that we will identify 20 useful strategies for different problems and put them up.”

In addition to developing the courses in the cartoon format used in their other online programs, Prof Andrews said they were also creating a version using animated mannequins to explore what format was the most attractive (examples of the animations below). Trials testing the animated courses will follow.

THIS WAY UP Clinic also offers three free self-help courses available to everyone aiming to help with shyness, stress management, and worry and sadness. Visit THIS WAY UP Self Help for more information.

Prof Andrews will give a presentation about CRUfAD’s research called ‘Not just for the young: Elderly thrive with internet treatment’ at the Health Informatics Society of Australia’s (HISA) upcoming annual health informatics conference (HIC). HIC 2014 is taking place from 11 – 14 August in Melbourne.

CRUfAD Dem_image2CRUfAD Dem_image1

CRUfAD Dem_image3The three images above are from an online program CRUfAD is developing for carers of people with dementia.

Tags: anxiety, depression, gavin-andrews, hic, online-education, online-health,

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