Tuesday, March 10, 2020

Digital Monitoring, Motivational Coaching May Decrease Depression in Older Bereaved Adults

The death of a spouse can disrupt routine daily activities, such as sleeping and eating, and increase risk of mood disorders, such as major depressive disorder (MDD). A small study published in the American Journal of Geriatric Psychiatry suggests that an intervention combining digital monitoring and motivational coaching may help older bereaved adults to better track and improve their sleeping, eating, and physical activity.

Evidence suggests that some 20% to 30% of older adults meet criteria for MDD in the year following the death of a spouse, but “[h]igh regularity in the timing of daily activities may protect against MDD,” wrote Sarah Stahl, Ph.D., of the University of Pittsburgh and colleagues.

Stahl and colleagues recruited adults aged 60 or older whose spouse had died within the past eight months and were identified by the researchers as being at high risk for MDD. (The researchers considered the following factors in assessing the participants’ risk of MDD: general medical comorbidities; subthreshold symptoms of depression, anxiety, and/or complicated grief; and low social support.)

Of the 152 people screened for the study, 57 were randomly assigned to one of three interventions: digital monitoring of sleep, meals, and physical activity; digital monitoring of sleep, meals, and physical activity plus motivational health coaching; or enhanced usual care. Those in the enhanced care group were followed on the same assessment schedule as the other participants and were referred to medical and or grief specialty care as necessary.

Participants who were assigned to digital monitoring recorded information on their sleep, meals, and physical activity twice daily in a diary-like app on a tablet for 12 weeks. Participants who were assigned to also receive motivational coaching received a weekly phone call from a health coach who used motivational interviewing techniques to motivate participants to engage in a regular routine. All participants wore an actigraphy watch on weeks 1 and 12 of the study and were assessed for depression at baseline, directly after the intervention period (12 weeks after baseline), and then three, six, and nine months later.

“We observed high levels of adherence in both digital monitoring (90%) and health coaching (92%),” Stahl and colleagues wrote. “Depression symptoms decreased from pre- to post-intervention; however, our sample was small, which affected power to detect differences between the three treatment arms.”

They concluded, “This pilot study demonstrated feasibility and acceptability of digital monitoring and motivational health coaching in older spousally bereaved adults at high risk for MDD.”

For related information, see the Psychiatric Services article “Toward Cultural Assessment of Grief and Grief-Related Psychopathology.”

(Image: iStock/shironosov)

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