Home-Based Telebehavioral Health for US Military Personnel and Veterans With Depression: A Randomized Controlled Trial

Objective: Evidence of feasibility, safety, and effectiveness of home-based telebehavioral health (HBTBH) needs to be established before adoption of HBTBH in the military health system can occur. The purpose of this randomized controlled noninferiority trial was to compare the safety, feasibility, and effectiveness of HBTBH to care provided in the traditional in-office setting among military personnel and veterans. Method: One hundred and twenty-one U.S. military service members and veterans were recruited at a military treatment facility and a Veterans Health Administration hospital. Participants were randomized to receive 8 sessions of behavioral activation treatment for depression (BATD) either in the home via videoconferencing (VC) or in a traditional in-office (same room) setting. Participants were assessed at baseline, midtreatment (4 weeks), posttreatment (8 weeks), and 3 months posttreatment. Results: Mixed-effects modeling results with Beck Hopelessness Scale and Beck Depression Inventory II scores suggested relatively strong and similar reductions in hopelessness and depressive symptoms for both groups; however, noninferiority analyses failed to reject the null hypothesis that in-home care was no worse than in-office treatment based on these measures. There were not any differences found between treatment groups in regards to treatment satisfaction. Safety procedures were successfully implemented, supporting the feasibility of home-based care. Conclusion: BATD can be feasibly delivered to the homes of active duty service members and veterans via VC. Small-group differences suggest a slight benefit of in-person care over in-home telehealth on some clinical outcomes. Reasons for this are discussed. What is the public health significance of this article? Behavioral activation treatment for depression can be feasibly delivered to the homes of active-duty U.S. service members and veterans. Small-group differences suggest a slight benefit of in-person care over in-home telehealth on some clinical outcomes. Telebehavioral health services provided to the home or other locations have the potential to address current and future health needs of military service members and veterans, especially for those who live in rural or underserved areas.