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Using WhatsApp to manage depression in older adults


Messaging app WhatsApp can be a very effective tool to help older people overcome loneliness and depression, according to the findings of a study conducted in Guarulhos, the second largest city in the state of São Paulo, Brazil.

Published in the magazine Natural medicineThe study was a randomized controlled trial that included 603 participants over 60 years of age, registered in 24 primary care clinics belonging to Brazil’s national public health network, Sistema Único de Saúde (SUS).

According to Professor Dr. Marcia Scazufca, co-author of the study and a scientific researcher at the Hospital das Clínicas of the University of São Paulo, the participants, the vast majority (74.8%) of whom were women, had been tested positive for depression and showed significant symptoms of the disorder.

Participant selection was based on responses to the Patient Health Questionnaire-9 (PHQ-9), a widely validated screening tool used to assess the presence and severity of depression on a scale of 0 to 27.

A score of 0 to 4 indicates no depression, and scores of 5 to 9, 10 to 14, 15 to 19, and 20 to 27 indicate mild, moderate, moderately severe, and severe depression, respectively.

“We invited all individuals with a score of 10 or more at the initial assessment to participate, so our sample included people with moderate and severe depression,” said Professor Scazufca.

The participants were then randomly divided into two groups.

“The intervention group, with 298 participants, received WhatsApp messages through the Viva Vida program twice a day, four days a week, for six weeks, with educational content on depression and behavioral activation.

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“The control group, with 305 participants, received a single message with educational content.

“Neither group received support from healthcare professionals,” Professor Scazufca explained.

The name of the program, Viva Vida, means “Long life.”

Although 603 people were initially recruited, only 527 (87.4%) completed the follow-up assessment.

Depressive symptoms improved in 42.4% of the intervention group, compared with 32.2% of the control group.

“This suggests that mobile phone messaging intervention was an effective short-term treatment for depression in older people in areas with limited health services,” said Professor Scazufca.

As many low-income Brazilian elderly are semi-literate or illiterate, the intervention group received three-minute audio messages or images, but no text messages.

The researchers were careful to use simple language inspired by popular radio shows.

Two actors, called under the pseudonyms Ana and Léo, read the messages, which ranged from educational phrases about depression to advice on behavioural activation and avoiding a relapse.

“The 10 percentage point difference between the intervention and control groups in terms of improvement may seem small, but considering the very low cost of Viva Vida and the large proportion of the population it could potentially reach, these 10 percentage points could represent millions of people.

“Furthermore, Viva Vida should be considered as a first step, which can be combined with other forms of intervention.

“It is important to note that the vast majority of participants had never received any form of treatment for depression and had not even been diagnosed with depression,” said Professor Scazufca.

The result is especially relevant in a middle-income country like Brazil, where the number of older people is increasing rapidly and mental health services are scarce, he added.

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The low cost of the programme and the ease with which it can be implemented means that it can be replicated in other countries with similar or worse socio-economic conditions, and where conventional treatment is unavailable or unaffordable for many.

“As we continue to advance in this type of research, we will be able to find even more solid evidence of the benefits of digital intervention in mental health and of expanding the coverage of psychosocial treatment worldwide,” he said. – By José Tadeu Arantes/Agência FAPESP



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