Technology is everywhere. You see the ubiquitous smartphone or tablet in the hands of the five-year-old in his car seat, the 15-year-old texting friends and the 35-year-old keeping up with the office while vacationing.
Choi's research has shown that medically ill, homebound older adults are more vulnerable to depression than their more active peers. Isolation and multiple stressors, Choi explains, can contribute to the problem.
"When I say isolation, I mean they are isolated from meaningful social engagement or social activities, even if there are a lot of people coming to their house, such as home health care workers, other service providers or informal caregivers," Choi says. "Older adults depend on other people for so many things, but it can be very stressful to have all these helpers in your home all the time."
Studies indicate that depressed older adults who take multiple medications for their conditions prefer talk therapy to antidepressant medications. Even so, there is a stigma and discomfort attached to seeking psychotherapy.
Choi experienced that firsthand as a Meals on Wheels volunteer, delivering meals and buying groceries for homebound seniors.
"One of my first grocery-shopping clients in Austin, an 86-year old woman, kept telling me, 'I am so depressed.' But she was reluctant to go to any clinic-based therapy because she didn't want to be seen doing so. In any case, she could not drive and could not afford other transportation, so she really had no way of getting to a therapy session," Choi says.
That volunteering experience prompted the idea for the Skype study, which focused on depressed, low-income homebound older adults.
Participants, who ranged in age from 50 to 80, were loaned laptop computers with Skype video call installed and prepaid USB 3G wireless cards. They were also provided with a headset for privacy.
Choi's study, funded by a $680,000 grant from the National Institute of Mental Health, used a method called Problem-Solving Therapy (PST) and compared the Skype videoconference sessions (tele-health PST) to in-person PST and telephone support calls.
PST stems from the theory that people with deficits in problem-solving skills become vulnerable to depression because they may not cope well under high levels of stress.
The program was referred to as "wellness at home" to help seniors move past their sense of stigma related to mental illness. Choi also reassured prospective participants, telling them, "Name one person that you know who didn't have any depression in life. This is part of life in this earth so you don't have anything to be ashamed about."
But there was another hurdle: The seniors were reluctant to use technology.
"Most of the people told me they hoped they got the in-person PST," Choi says.
Over the course of 36 weeks, participants were evaluated for items such as acceptability of the treatment, likeability of the procedures used and negative aspects, such as any side effects or discomfort with the type of treatment.
Results showed a significant reduction in depression symptoms. And surprisingly, Choi saw higher evaluation scores from the tele-PST group than the in-person PST group.
"About 90 percent of them said that it was a life-changing experience for them," Choi says. "Some people cried as they talked about how much they've changed and how PST helped them get out of depression."
Choi says they appreciated the privacy of tele-PST, along with the convenience. "They said, 'Oh I don't feel guilty about not cleaning my house. I can do it in my pajamas and I can still see the therapist as if she's sitting right next to me.'"
The biggest bonus of tele-PST was the technology itself, or what Choi calls the "cool" factor. Study participants said they loved using the computer and the videoconferencing system.
"The computer therapy gave me confidence to try new things, and I was able to text my granddaughter back when she sent me a text message!" reported one 84-year-old participant. "I feel empowered by the therapy."
Choi's study also received funding from the St. David's Foundation and the Roy F. and Joann Cole Mitte Foundation. A longer version of this story originally appeared in the School of Social Work's magazine, The Utopian.
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