Interpersonal psychotherapy is a common, in-person treatment for depression, but new research from the University of Georgia found that this type of one-on-one therapy can be successfully delivered over the telephone.
The findings offer an important new opportunity for treating depression among those living with HIV in a rural place.
This is the first study to show that telephone-administered interpersonal psychotherapy, or tele-IPT, can reduce depression over the long term in a clinical population, said lead author Timothy Heckman, professor of health promotion and behavior at UGA's College of Public Health.
Heckman was particularly interested in finding a way to help HIV-positive individuals living in rural areas because they face unique challenges that their urban dwelling counterparts do not.
Previous work has shown that people living with HIV/AIDS in rural areas are more likely to be depressed and are less likely to see a mental health provider. They also often lack the support of their friends, family and community.
"When you experience a health crisis, you expect that your neighbors and friends would rally around you," said Heckman. "In rural communities, having HIV is the exact opposite."
In addition to feeling sad, hopeless and fatigued, having depression contributes to nonadherence to antiretroviral treatment, said Heckman. This not only compromises an infected person's immune system and overall health, but also increases the chance of transmitting the virus to an uninfected person.
Yet, the stigma associated with having HIV/AIDS discourages some from seeking the care they need.
"Individuals living with HIV/AIDS are often reluctant to go to an AIDS-identified venue on a certain date at a certain time week after week because people will know why they are going there," said Heckman. "So, in these rural areas even if there are services available, people might be reluctant to use them."
Teletherapy is inexpensive, maintains privacy, and meets patients where they are, Heckman said. He and his colleagues conducted a randomized clinical trial involving 147 HIV-infected individuals living in rural communities across 28 states to test tele-IPT's depression treatment efficacy.
Study participants received nine weekly phone calls from a clinical psychologist and reported their progress immediately after completing the therapy and in four and eight months after treatment ended. Results showed that the benefits of tele-IPT persisted, and tele-IPT patients also used emergency hotlines less frequently than patients receiving standard treatments.
Heckman said the next step is to work with AIDS service organizations and practitioners in rural communities to roll out treatment to people who need it. He also hopes that these results will have an impact on reimbursement policy. Currently, clinical psychologists are rarely reimbursed for delivering treatments over the phone.
"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. "We hope that this type of teletherapy will reach people who otherwise won't get access to the treatments that they need."