JMIR Publications

ABSTRACT

Background:

Loss of a loved one is a common, yet stressful event in later life. Internet and mobile-based interventions have been proposed as an effective treatment approach for individuals with prolonged grief.

Objective:

The aim of the AgE-health study was to investigate the effectiveness of the eHealth intervention trauer@ktiv in reducing prolonged grief symptoms in a sample of older adults. Trauer@ktiv is an unguided web-based self-management intervention based on cognitive-behavioral therapy principles addressing grief in later life.

Methods:

The AgE-health study is designed as a randomized controlled trial (RCT) with an active control group. Recruitment and data assessment took place between October 2020 and September 2022. A sample of N=177 older adults (60+ years) with prolonged grief symptoms were randomly assigned to the intervention group (IG; access to the eHealth intervention trauer@ktiv) or the active control group (CG; access to an information brochure on loss and grief). Participants were interviewed at two points in time before and after accessing the intervention (baseline, BL; 4 months after the intervention, FU). Primary outcome was the reduction in prolonged grief symptoms assessed with the PG-13. Adjusted mixed-effects regression models were used to test for changes in primary and secondary outcomes (e.g. depression, self-efficacy) as part of an intention-to-treat (ITT) analysis. The study procedure is described in detail in the study protocol (Welzel et al., 2021).

Results:

From BL to FU, N=7 participants were lost to follow-up. Final analyses included a sample of N=170 individuals (IG: N=81, CG: N=89). The study population was on average 67.3 years old (range: 60 to 95 years) and predominantly female (75.9%). While there was a pre-post reduction in persistent grief symptoms, the ITT analysis showed no significant differences between IG and CG at FU (PG-13, average marginal effect = 0.56, 95%CI: -2.30 - 3.44). Similarly, the ITT analysis showed no significant treatment effects for any of the secondary outcomes at FU. The intervention trauer@ktiv was rated high on satisfaction and usability. More than half of the IG (N=49, 60.5%) completed five or more of eight modules of the eHealth intervention.

Conclusions:

The tested eHealth intervention trauer@ktiv showed no superiority compared to an active control group in reducing prolonged grief symptoms in a sample of older bereaved individuals. Therefore, trauer@ktiv is not suitable as a stand-alone treatment. However, as the ease of use and satisfaction with the application were high, there may be potential of the intervention within a stepped and collaborative treatment approach. Clinical Trial: The study has been registered at the German Clinical Trials Register (Identifier: DRKS00020595, Registered 30th July 2020).