{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:54:03Z","timestamp":1783040043794,"version":"3.54.6"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Digital Mental Health Interventions (DMHI) can diminish inequities in mental health care provision. As DMHIs increase in popularity, however, older adults may be unintentionally excluded due to barriers such as lack of awareness, internet access, digital tools, technological socialization and education, physiological accessibility, and communication technology infrastructure. The aim of this study was to examine longitudinal treatment engagement patterns and 15-week clinical outcomes of depressed and anxious older adults compared to a matched cohort of younger adults seeking treatment from a large asynchronous telemedicine provider.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The 2,470 older adults (55+ years) and a matched cohort of younger adults (26\u201335 years) diagnosed with depression or anxiety were treated by licensed therapists <jats:italic>via<\/jats:italic> messaging 5 days a week. Patterns of treatment engagement on the platform were compared across groups by examining total number of days in treatment, days actively messaging on the platform, and average words and messages per week sent by patients over the entire period they remained in treatment. Symptoms were assessed every 3 weeks using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), and changes were compared across age groups over 15 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Older patients attended more days in treatment than younger patients, but there were no differences in number of days actively messaging on the platform, number of messages per week, or word count per week. The two age groups did not differ in their final anxiety or depressive symptoms when controlling for total number of weeks attended. Patients in the younger age group experienced a quicker rate of reduction than older adults in their anxiety, but not depressive symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among individuals willing to initiate care through a DMHI, older adults had overall similar engagement as younger adults and they showed similar improvement in symptoms of depression and anxiety. Given the advantages of message-based care for aiding a mental health workforce in serving larger numbers of individuals in need and the expected growth of the aging population, these findings could help healthcare systems in evaluating a variety of treatment options and delivery media for meeting the healthcare needs of the future.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2022.951354","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T09:16:33Z","timestamp":1661418993000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Message-based psychotherapy for older adults: A cohort comparison study"],"prefix":"10.3389","volume":"13","author":[{"given":"Patrick J.","family":"Raue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Fridling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyoung","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D.","family":"Hull","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George S.","family":"Alexopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A.","family":"Arean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"B1","unstructured":"Washington (DC)National Academies Press (US)Retooling for an Aging America: Building the Health Care Workforce.2008"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1001\/jama.2017.3826","article-title":"Depression is the leading cause of disability around the world","volume":"317","author":"Friedrich","year":"2017","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1016\/S0140-6736(05)66665-2","article-title":"Depression in the elderly","volume":"365","author":"Alexopoulos","year":"2005","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.jad.2008.07.004","article-title":"Economic impact of non-persistence to antidepressant therapy in the Quebec community-dwelling elderly population","volume":"115","author":"Tournier","year":"2009","journal-title":"J Affectiv Disord."},{"key":"B5","doi-asserted-by":"publisher","first-page":"f2570","DOI":"10.1136\/bmj.f2570","article-title":"Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care","volume":"346","author":"Gallo","year":"2013","journal-title":"BMJ."},{"key":"B6","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1017\/S1041610212001688","article-title":"Direct costs associated with depressive symptoms in late life: a 4.5-year prospective study","volume":"25","author":"Luppa","year":"2013","journal-title":"Int Psychogeriatric."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1176\/appi.ajp.2010.09091327","article-title":"Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction","volume":"167","author":"Are\u00e1n","year":"2010","journal-title":"Am J Psychiatry."},{"key":"B8","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.psc.2011.03.001","article-title":"Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects","volume":"34","author":"Kiosses","year":"2011","journal-title":"Psychiatr Clin North Am."},{"key":"B9","doi-asserted-by":"publisher","first-page":"5180","DOI":"10.1038\/s41380-020-0832-3","article-title":"Comparing the streamlined psychotherapy Engage with problem-solving therapy in late-life major depression. a randomized clinical trial","volume":"26","author":"Alexopoulos","year":"2021","journal-title":"Mol Psychiatry."},{"key":"B10","unstructured":"NelsonJC\n            DelucchiK\n            SchneiderLS\n          Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. 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