Effects of Cognitive Behavioral Therapy and Cash Transfers on Older Persons Living Alone in India : A Randomized Trial.
Ann Intern Med
; 176(5): 632-641, 2023 05.
Article
in English
| MEDLINE | ID: covidwho-2299860
ABSTRACT
BACKGROUND:
A growing number of older persons in developing countries live entirely alone and are physically, mentally, and financially vulnerable.OBJECTIVE:
To determine whether phone-based cognitive behavioral therapy (CBT) or a cash transfer reduce functional impairment, depression, or food insecurity in this population.DESIGN:
Randomized controlled trial. (ClinicalTrials.gov NCT04225845; American Economic Association RCT Registry AEARCTR-0007582).SETTING:
Tamil Nadu, India, 2021.PARTICIPANTS:
1120 people aged 55 years and older and living alone.INTERVENTIONS:
A 6-week, phone-based CBT and a 1-time cash transfer of 1000 rupees (U.S. $12 at market exchange rates) were evaluated in a factorial design. MEASUREMENTS The World Health Organization Disability Assessment Schedule (WHODAS), the Geriatric Depression Scale, and food security, all measured 3 weeks after CBT for 977 people and 3 months after for 932. Surveyors were blind to treatment assignment.RESULTS:
The WHODAS score (scale 0 to 48, greater values representing more impairment) decreased between baseline and the 3-week follow-up by 2.92 more (95% CI, -5.60 to -0.23) in the group assigned cash only than in the control group, and the depression score (ranging from 0 to 15, higher score indicating more depressive symptoms) decreased by 1.01 more (CI, -2.07 to 0.06). These effects did not persist to the 3-month follow-up, and CBT alone and the 2 together had no significant effects. There were no effects on food security.LIMITATIONS:
The study cannot say whether more sustained or in-person therapy would have been effective, how results would translate outside of the COVID-19 period, or whether results in the consented sample differ from those in a larger population. Primary outcomes were self-reported.CONCLUSION:
Among older people living alone, a small cash transfer was effective in alleviating short-term (3 weeks) functional impairment, produced a small but not clinically or statistically significant reduction in depression, and had no effect on food security. There were no short-term effects from CBT or the 2 interventions together. None of the interventions showed any effect at 3 months. PRIMARY FUNDING SOURCE National Institute on Aging (NIA).
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Cognitive Behavioral Therapy
/
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Aged
/
Humans
Country/Region as subject:
Asia
Language:
English
Journal:
Ann Intern Med
Year:
2023
Document Type:
Article
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