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Phone-administered psychotherapy reduces depressive symptoms in rural adults with HIV, finds study

February 7, 2018 depression

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Phone-administered psychotherapy reduces depressive symptoms in rural adults with HIV, finds study

Residents of rural areas account for 5-7 percent of all individuals suffering from HIV in the United States.  Rural people living with HIV (PLHIV) have a 1.3 time higher likelihood of receiving a diagnosis for depression than PLHIV in urban areas. Such individuals also experience increased suicide ideation and loneliness, and face difficulty in accessing health care services and social support. A high prevalence of depression and loneliness among rural PLHIV is associated with faster disease progression and higher rates of mortality.

Although interpersonal psychotherapy is a common treatment for depression, a new study from the University of Georgia (UGA) found that such one-on-one therapy could be successfully administered via the telephone. Findings of the research, published in the Annals of Behavioral Medicine in January 2018, showed that telephone-administered interpersonal psychotherapy (tele-IPT) reduced depressive symptoms in a clinical population over the long-term. The findings opened new avenues for treating depression among rural PLHIV.

Lead researcher Timothy G. Heckman, a professor and associate dean for research at UGA’s College of Public Health, wanted to find a way to help HIV-positive individuals dwelling in rural areas since they faced unique challenges which corresponding PLHIV in urban areas did not. According to Heckman, besides inducing loneliness, hopelessness and fatigue, depression results in non-adherence to antiretroviral treatment (ART). This compromises an infected person’s immune system and overall health, and also increases the risk of transmitting HIV to an uninfected person.

Tele-IPT can overcome many barriers to mental health treatment

The stigma associated with HIV/AIDS prevents many affected individuals in rural areas from seeking health care services, including mental health services. Such individuals also lack a support network comprising friends, family and community members. Past research from Heckman and his colleagues found that “geographic isolation, physical limitations, and confidentiality concerns” preclude many from accessing psychological services. To determine if tele-IPT could effectively treat depression, Heckman and other researchers conducted a new randomized clinical trial involving 147 HIV-infected individuals living in rural communities across 28 states.

Study participants received nine weekly phone calls from a clinical psychologist. Using self-reporting techniques, participants measured their progress immediately after completing the therapy, and also in the two follow-up periods: four and eight months after the treatment ended. The benefits of tele-IPT were found to be long-lasting. Moreover, tele-IPT patients used crisis hotlines less frequently immediately after treatment and at the four-month follow-up, compared to those receiving standard care. According to Heckman, phone-based therapy was inexpensive, maintained privacy and avoided the need to travel physically.

“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. Moreover, he expressed hope that this form of tele-therapy would reach people who were otherwise unable to access the treatment they needed. As the next step, the researchers plan to work with AIDS service organizations and practitioners in rural communities to provide treatment to people requiring it.

Depression and mental health in rural America

Although depression typically strikes irrespective of age, gender, geographical location or socioeconomic background, past research showed that the prevalence of depression was slightly but significantly higher among people living in rural areas (6.1 percent) compared to those in urban areas (5.2 percent), possibly due to differences in population characteristics. Previous research also found that rural communities had a smaller proportion of behavioral health care providers (psychiatrists, clinical psychologists, psychiatric nurse practitioners, social workers and counselors) than urban areas.

Viewed in the larger context of mental health care in rural America, studies have found that over 6.5 million people (18.7 percent) in nonmetropolitan areas had a diagnosable mental illness in 2016. Residents in rural areas had significantly lower access to care, and there was a chronic shortage of mental health professionals due to their likelihood of practicing in urban areas. Tele-mental health “can address the most basic to hurdles to rural mental health care, including shortages of mental health clinicians and extended travel distances.”

Depression and other mental illnesses can be addressed with timely intervention. Contact the Recover Mental Health for information on evidence-based programs for depression treatment. Call our 24/7 helpline number 866-593-2339 or chat online with one of our experts to know more about the best depression treatment center in your vicinity.

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