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Empathy-Focused Phone Calls Alleviate Loneliness, Depression, Anxiety During COVID-19 Pandemic

Feb. 23, 2021

AUSTIN, Texas – Social isolation arising from COVID-19 has sparked significant mental health issues, resulting in a jump from 1 in 10 adults reporting anxiety or depressive disorder symptoms before the pandemic to 1 in 3 adults more recently. But new research published today in JAMA Psychiatry shows that loneliness, depression, anxiety and overall mental health among older people can be improved through an empathy-focused telephone program.

Known as “Sunshine Calls,” the four-week program was conducted as a randomized controlled trial of 240 mostly homebound, older adults. Lay callers engaged in telephone conversations with program participants; about half lived alone, and all reported having at least one chronic health condition. Compared with those who didn’t receive calls, recipients reported an average improvement of more than 1 point out of a 7-point standard scale in their feelings of loneliness, equaling a 16% difference. The number of adults who were at least mildly anxious at the outset dropped by 37% by the end of the program, and the number who were at least mildly depressed at baseline dropped by 25%, according to study authors.

The Sunshine Calls program was developed by Factor Health, an initiative of Dell Medical School at The University of Texas at Austin and the Episcopal Health Foundation, in collaboration with Meals on Wheels Central Texas. Factor Health tests and builds programs at scale to deliver health outside of traditional settings, such as clinics and hospitals.

“We found that people feel meaningfully better when someone connects with them on their terms, consistently and authentically,” said lead study author Maninder “Mini” Kahlon, Ph.D., associate professor of population health and executive director of Factor Health at Dell Med. “In a time of overwhelming need for mental health services across America, this approach offers rapid improvements in loneliness, depression and anxiety. Better still, it’s scalable because it’s delivered by people who are not mental health professionals,” said Kahlon.

The study adds to a growing body of evidence on the connection between loneliness and health, as well as on how mental health conditions can be meaningfully improved through new kinds of programs relying on everyday people, when clinicians aren’t necessary.

Callers, ages 17-23 years old, underwent a 1-hour video training to help them prioritize empathetic listening and eliciting conversation during the calls. Each caller supported six to nine participants during the pilot. Call recipients dictated the frequency and time of day for when they wanted to receive the calls, which usually lasted on average about 10 minutes. Researchers tracked participants’ loneliness, anxiety, depression and overall mental health using several widely accepted measurement tools that were administered as questionnaires, answered before and after the pilot program. Participants were largely women, mostly single, with 39% self-reporting as Black or African American and 22% as Hispanic or Latino.

“Loneliness, depression and feelings of isolation are ‘viruses’ that can negatively affect the health of the vulnerable homebound older Central Texans we serve,” says Adam Hauser, president and CEO of Meals on Wheels Central Texas. “During the pandemic, our clients are receiving few — if any — visitors other than our dedicated volunteers who safely deliver their meals. Sunshine Calls fill that void with caring conversations that make a world of difference in the lives of homebound seniors.”

Factor Health experts are available to support similar existing telephone outreach programs to help maximize program effectiveness. Researchers are currently seeking funding to maximize reach, measure impact, and demonstrate effectiveness at scale. Factor Health is also seeking health insurers, self-insured employers and other potential partners to test methods to pay for outcomes that enable health systems to create effective programs.