Category: Adult Depression / Dysthymia

PS3- #B43 - Depression and Anxiety Levels in Behavioral Activation Teletherapy Among Low-Income, Primary Care Patients

Friday, Nov 17
11:00 AM – 12:00 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Behavioral Activation | Depression | Technology / Mobile Health

Behavioral Activation (BA) is an empirically-supported treatment for major depressive disorder (Dimidjian, Barrera, Martell, Munoz, & Lewinsohn, 2011; Dimidjian et al., 2006) that conceptualizes that depression stems from an inability to experience achievement and pleasure from daily life events. Primary care is an ideal setting in which to identify and treat major depression, given the high patient volume, the co-occurrence of depression within primary care (Katon & Schulberg, 1992), and the lack of mental health screening in these settings. In order to apply BA to diverse contexts, we adapted existing protocols to offer BA as teletherapy to patients attending primarily low-income, charity primary care clinics. Offered in English and Spanish, teletherapy was selected as the treatment modality to ease the financial and logistical barriers to accessing in-person care at a new location. To achieve this objective, teletherapy was offered to patients either in their primary care clinics or at their homes. 

Prior writing and analyses  (Trombello & Trivedi, in press; Trombello et al., in preparation) with 74 patients receiving at least one out of up to eight weekly psychotherapy sessions demonstrated that BA teletherapy was associated with declines in depressive and anxious symptoms, as measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7).  Mean PHQ-9 symptoms declined from 14.46 at intake (n = 74) to 5.75 at session 8 (n = 28), while mean GAD-7 symptoms declined from 11.91 at intake (n = 69) to 5.73 at session 8 (n = 26).  Furthermore, the majority of patients (n = 38, 52.8%) out of 72 not already in depression remission at intake who received at least one psychotherapy session achieved depression remission (i.e., PHQ-9 < 5) at some point throughout their psychotherapy course, with 33/38 (86.8%) achieving sustained remission until their final therapy session. Plots of the individual trajectories suggested the potential for quadratic growth models with added random effects to the intercept, linear, and quadratic terms. Mixed effects modeling indicated that the linear and quadratic fixed effects were highly significant (linear: t367 = -9.23, p < .001; and quadratic: t367 = 6.97, p < .001). The linear effect further showed that a 1 session increase on average decreased PHQ-9 scores by 3.12 points, with a positive quadratic term indicating a convex trajectory. A likelihood ratio test found that the quadratic growth model provided a significantly better fit than the linear growth model alone (X24 = 83.7, p < .001). Additional analyses will consider whether patients’ demographic factors (gender, race, ethnicity, and primary spoken language) and intake psychiatric diagnoses are associated with differences in intercepts and slopes of depressive/anxious symptoms over time. 

Joseph M. Trombello

Assistant Professor of Psychiatry
University of Texas Southwestern Medical Center
Dallas, Texas

Charles South

University of Texas Southwestern Medical Center

Audrey Cecil

University of Texas Southwestern Medical Center

Katherine Sanchez

University of Texas at Arlington

Alma Sanchez

University of Texas Southwestern Medical Center

Sara Levinson Eidelman

University of Texas Southwestern Medical Center

Taryn Mayes

University of Texas Southwestern Medical Center

Farra Kahalnik

University of Texas Southwestern Medical Center

Corey Tovian

University of Texas Southwestern Medical Center

Beth Kennard

Professor of Psychiatry
Children's Health – Children's Medical Center/University of Texas Southwestern Medical Center, Texas

Madhukar Trivedi

University of Texas Southwestern Medical Center