Interpersonal psychotherapy is a common, in-person treatment for depression, but research from the University of Georgia found that this type of one-on-one therapy can be successfully delivered over the telephone. The findings offer an important new opportunity for treating depression among those living with HIV in a rural place.
This is the first study to show that telephone-administered interpersonal psychotherapy, or tele-IPT, can reduce depression over the long term in a clinical population, said lead author Timothy Heckman, professor of health promotion and behaviour at UGA’s College of Public Health.
Heckman and colleagues as well as researchers from Columbia College of Physicians and Surgeons, Ohio University, Oregon Health and Science University and Indiana University, were particularly interested in finding a way to help HIV-positive individuals living in rural areas because they face unique challenges that their urban dwelling counterparts do not.
Previous work has shown that people living with HIV/Aids in rural areas are more likely to be depressed and are less likely to see a mental health provider. They also often lack the support of their friends, family and community. “When you experience a health crisis, you expect that your neighbours and friends would rally around you,” said Heckman. “In rural communities, having HIV is the exact opposite.”
In addition to feeling sad, hopeless and fatigued, having depression contributes to nonadherence to antiretroviral treatment, said Heckman. This not only compromises an infected person’s immune system and overall health, but also increases the chance of transmitting the virus to an uninfected person.
Yet, the stigma associated with having HIV/Aids discourages some from seeking the care they need. “Individuals living with HIV/Aids are often reluctant to go to an Aids-identified venue on a certain date at a certain time week after week because people will know why they are going there,” said Heckman. “So, in these rural areas even if there are services available, people might be reluctant to use them.”
Teletherapy is inexpensive, maintains privacy, and meets patients where they are, Heckman said. He and his colleagues conducted a randomized clinical trial involving 147 HIV-infected individuals living in rural communities across 28 states to test tele-IPT’s depression treatment efficacy.
Study participants received nine weekly phone calls from a clinical psychologist and reported their progress immediately after completing the therapy and in four and eight months after treatment ended. Results showed that the benefits of tele-IPT persisted, and tele-IPT patients also used emergency hotlines less frequently than patients receiving standard treatments.
Heckman said the next step is to work with Aids service organisations and practitioners in rural communities to roll out treatment to people who need it. He also hopes that these results will have an impact on reimbursement policy. Currently, clinical psychologists are rarely reimbursed for delivering treatments over the phone.
“Some people are not comfortable in face-to-face settings and now they have an efficacious treatment they can participate in without leaving the safety and the confines of their homes,” said Heckman. “We hope that this type of teletherapy will reach people who otherwise won’t get access to the treatments that they need.”
Background: Rural areas account for 5% to 7% of all HIV infections in the USA, and rural people living with HIV (PLHIV) are 1.3 times more likely to receive a depression diagnosis than their urban counterparts. A previous analysis from our randomized clinical trial found that nine weekly sessions of telephone-administered interpersonal psychotherapy (tele-IPT) reduced depressive symptoms and interpersonal problems in rural PLHIV from preintervention through postintervention significantly more than standard care but did not increase perceived social support compared to standard care.
Purpose: To assess tele-IPT’s enduring effects at 4- and 8-month follow-up in this cohort.
Methods: Tele-IPT’s long-term depression treatment efficacy was assessed through Beck Depression Inventory self-administrations at 4 and 8 months. Using intention-to-treat and completer-only approaches, mixed models repeated measures, and Cohen’s d assessed maintenance of acute treatment gains.
Results: Intention-to-treat analyses found fewer depressive symptoms in tele-IPT patients than standard care controls at 4 (d = .41; p < .06) and 8-month follow-up (d =.47; p < .05). Completer-only analyses found similar patterns, with larger effect sizes. Tele-IPT patients used crisis hotlines less frequently than standard care controls at postintervention and 4-month follow-up (ps < .05).
Conclusions: Tele-IPT provides longer term depression relief in depressed rural PLHIV. This is also the first controlled trial to find that IPT administered over the telephone provides long-term depressive symptom relief to any clinical population.
Timothy G Heckman, John C Markowitz, Bernadette D Heckman, Ye Shen, Henok Woldu, Mark Sutton, Timothy Anderson, Travis I Lovejoy, William Yarber