Empathetic Phone Calls From Laypersons Reduce Loneliness, Depression in Homebound Adults

By Linda Carroll

February 24, 2021

(Reuters Health) - A layperson-delivered empathy-oriented phone call program may reduce loneliness as well as depression and anxiety in homebound adults, a new study suggests.

Based on analysis of data from 240 mostly homebound adults who were randomly assigned to be called by volunteers rapidly-trained in empathetic conversational techniques, or not to receive phone calls during the four-week study period, researchers found that the calls significantly improved mental health, according to the results in JAMA Psychiatry.

"Our hypothesis was that we would impact loneliness," said the study's lead author, Maninder Kahlon, an associate professor in population health, vice dean for health ecosystem and director of Factor Health at the Dell Medical School of the University of Texas at Austin.

"We were surprised that the intervention had significant impacts on depression and anxiety and we now want to quickly build on that," Kahlon said. "Given that the approach used lightly trained lay callers, it may be easily scalable," Kahlon noted, adding that such a program might be very helpful in a time when there is a shortage of mental health providers.

In the four-week program, dubbed "Sunshine Calls," lay callers engaged in regular phone conversations with study participants, all of whom reported having at least one chronic condition and about half of whom lived alone. Meals on Wheels Central Texas initially referred 510 people for the study, but the researchers were only able to contact 296, and ultimately enrolled 240, randomizing half to the active arm of the study and half to a control group that received the intervention after the four-week study period had concluded.

The callers, students aged 17 to 23, underwent a one-hour video training session to help them prioritize empathetic listening and learn how to elicit conversation during a call by asking questions about topics raised by the participants. Each of the volunteers supported six to nine participants during the pilot study.

Those in the active treatment group received daily calls for the first five days, and were then asked how many times a week they'd like to be contacted in the future and what time of day they would like the calls to occur. The calls usually lasted an average of 10 minutes.

This procedure helped empower the participants, Kahlon said. "It was important that they decided what to talk about and how long to talk. It was all on their terms," she added. "The participants spoke about anything and everything."

The primary outcome was loneliness, measured with the 6-item De Jong scale (score range, 0-6) and the 3-item UCLA Loneliness Scale (score range, 3-9), with higher numbers implying greater loneliness.

Compared with the control group, call recipients scored a statistically significant improvement of 1.1 points on the UCLA Loneliness Scale, which amounted to a 16% difference. The improvement achieved on the De Jong Scale was not statistically significant.

Secondary outcomes included depression symptoms measured by the Personal Health Questionnaire for Depression (PHQ-8), and anxiety symptoms measured by the Generalized Anxiety Disorder scale (GAD-7).

Participants in the intervention experienced statistically significant improvements in both anxiety and depression symptoms, while both scores worsened in the control group over the study period, the authors note.

Dr. Craig Katz applauded the authors of the new study.

"This is a brilliantly conceived outreach project in which they matched people in need with what it is hard not to imagine was an enthusiastic group of college-age volunteers wishing to help in the pandemic," said Dr. Katz, a clinical professor in the department of psychiatry, medical education and health system design and director of the Program in Global Mental Health at the Icahn School of Medicine at Mount Sinai, in New York City.

"It shows that quite often there are non-psychological solutions - that is, brief, compassionate phone calls a few times/week - to psychological problems," Dr. Katz, who was not involved in the study, said in an email.

"It is also impressive that they paired research with this service program," Dr. Katz said noted. "This is never easy to do in the middle of a disaster and is in fact rarely attempted or accomplished. It therefore enabled them to capture, in a scientific way, what intuition tells you should work."

One limitation of the study is the large number of people whom the researchers were not able to reach, Dr. Katz said. "We don't know anything about the 214 people referred by MOWCTX that the researchers could not reach," he added. "One would be concerned that they were worse off than those whom the researchers did reach and enroll and maybe did not participate because they were so demoralized or even clinically depressed. If they had participated, would they have been harder to help and hence reduced the impact of their intervention?"

SOURCE: https://bit.ly/3r0Vcfj JAMA Psychiatry, online February 23, 2021.