Optimizing future Telehealth mental health programs: a secondary analysis of a prospective cohort study to identify key predictors of intervention response in the Telehealth intervention program for older adults (TIP-OA).

backgroundThe Telehealth Intervention Program for Older Adults (TIP-OA) was a volunteer-based phone support program for to older adults during the COVID-19 pandemic. While volunteer-based phone programs can be effective in providing mental health support, there is limited data on the predictors of response to such interventions. This study aimed to examine clinical and demographic predictors of response to the TIP-OA intervention among older adults.

methodsThis secondary analysis of a prospective cohort study included 82 TIP-OA users who expressed interest in the program’s research component, met inclusion criteria, and provided informed consent. Participants completed both baseline and 8-week assessments or had 4-week data carried forward using the last observation carried forward (LOCF) method. The intervention consisted of weekly supportive phone calls over eight weeks. Baseline mental health risk level was assessed by clinicians during intake and categorized as low, medium, or high based on symptom severity within specific symptom categories. Associations between baseline risk level and changes in stress (primary outcome), depression, and anxiety (secondary outcomes) were examined. The primary outcome was measured by the Perceived Stress Scale (PSS; scores ranging from 0 (never) to 4 (very often)). Secondary outcomes were measured by the Patient Health Questionnaire-9 (PHQ-9; scores ranging from 0 (not at all) to 3 (nearly every day)), and the Generalized Anxiety Disorder-7 scale (GAD-7; scores can range from 0 (not at all sure) to 3 (nearly every day)).

resultsAt 8 -week follow-up assessment, participants with higher baseline risk levels showed greater reductions in stress (mean difference in Perceived Stress Scale reduction by 2.13, (F(1,77) = 2.82, p = 0.09, 95% CI [−0.46, 5.56]) and depression (t(73) = −1.92, p = 0.059; Std. beta = −0.43, 95% CI [−0.87, 0.02]). Additionally, not identifying as a visible minority predicted lower stress scores, while male gender and a university education level were associated with greater reductions in depression scores.

conclusionTIP-OA participants with higher baseline mental health risk appeared to benefit more in terms of reductions in stress and depression. Non-minority status, male gender, and university education were also associated with better post-intervention outcomes in depression. Future studies should explore predictors of response in similar intervention programs through larger confirmatory studies.

trial registrationRegistered on clinicaltrials.gov (clinical trial no.: #NCT04523610) on 16/07/2020.