Internet-based cognitive behavioral therapy for psychological distress in older adults without cognitive impairment living in nursing homes during the COVID-19 pandemic: A feasibility study

Yuchen Ying; Yunxin Ji; Fanqian Kong; Qiqi Chen; Yueer Lv; Yanbin Hou; Lijie Zhu; Pingping Miao; Libo Yu; Laiyou Li; Wei Kuang; Lingli Jiang; Xiaozhuo Zhu; Xiaozhuang Liu; Le Xu; Yuwei Mi; Zhongze Lou; Liemin Ruan

doi:10.1016/j.invent.2021.100461

Internet-based cognitive behavioral therapy for psychological distress in older adults without cognitive impairment living in nursing homes during the COVID-19 pandemic: A feasibility study

Internet Interv. 2021 Dec:26:100461. doi: 10.1016/j.invent.2021.100461. Epub 2021 Oct 1.

Authors

Yuchen Ying^{1

2

3}, Yunxin Ji¹, Fanqian Kong⁴, Qiqi Chen², Yueer Lv², Yanbin Hou¹, Lijie Zhu⁵, Pingping Miao¹, Libo Yu², Laiyou Li², Wei Kuang², Lingli Jiang², Xiaozhuo Zhu², Xiaozhuang Liu², Le Xu³, Yuwei Mi³, Zhongze Lou^{1

6}, Liemin Ruan¹

Affiliations

¹ Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China.
² Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China.
³ School of Medicine, Ningbo University, Ningbo, Zhejiang, PR China.
⁴ Department of Medical Record and Statistics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, PR China.
⁵ Department of Statistics and Programming, Jiangsu Hengrui Pharmaceuticals Co. Ltd, Shanghai, PR China.
⁶ Central Laboratory of the Medical Research Center, Ningbo First Hospital, Ningbo, Zhejiang, PR China.

Abstract

Background: The COVID-19 pandemic has had a detrimental effect on the mental health of older adults living in nursing homes. Very few studies have examined the effects of Internet-based Cognitive Behavioral Therapy (ICBT) on older adults living in nursing homes during the pandemic. We conducted a feasibility study using a single-group design, to explore the effectiveness of ICBT on psychological distress in 137 older adults (without cognitive impairment) from 8 nursing homes in 4 southeast cities in China, between January and March 2020.

Methods: Symptoms of depression, anxiety, general psychological distress, and functional disability were measured at baseline, post-treatment (5 weeks) and at a 1-month follow-up. Mixed-effects model was used to assess the effects of ICBT.

Results: Statistically significant changes with large effect sizes were observed from pre- to post-treatment on the PHQ-9 (p < .001, Cohen's d = 1.74), GAD-7 (p < .001, d = 1.71), GDS (p < .001, d = 1.30), K-10 (p < .001, d = 1.93), and SDS (p < .001, d = 2.03). Furthermore, improvements in treatment outcomes were sustained at 1-month follow-up, and high levels of adherence and satisfaction were indicated.

Conclusion: ICBT was effective in reducing psychological distress in older adults without cognitive impairments living in nursing homes during the COVID-19 pandemic. Thus, it could be applied in improving the mental health of this vulnerable group during the pandemic.

Keywords: CBT, cognitive behavioral therapy; CIs, confidence intervals; COVID-19; DSM-IV, The Diagnostic and Statistical Manual of Mental Disorders-4th edition; Feasibility study; GAD-7, Generalized Anxiety Disorder 7-item; GDS, Geriatric Depression Scale; ICBT, Internet-based cognitive behavioral therapy; ITT, intention-to-treat; Internet-based cognitive behavioral therapy; K-10, 10-item Kessler Psychological Distress Scale; LOCF, last observation carried forward; MMRM, mixed-effects model for repeated measure; Mental health; Older adults; PHQ-9, Patient Health Questionnaire 9-item; Psychological distress; RCT, randomized controlled trials; REML, restricted maximum likelihood; SD, standard deviation; SDS, Sheehan Disability Scales; UN, unstructured.