A Randomised Controlled Trial of Clinician-Guided Internet-Based Cognitive Behavioural Therapy for Depressed Patients in Singapore.

Sharon H. X. Lu,Trisha E. L. Teoh,Tammie R. R. Kwek,Shaun W. H. Ng,Geoffrey C. Y. Tan,Hanita A. Assudani

doi:10.3389/fpsyg.2021.668384

Abstract

This study examined the efficacy and acceptability of a hybrid, clinician-guided internet-based Cognitive Behavioural Therapy (iCBT) programme for outpatients with depression in a psychiatric hospital in Singapore. Fifty three participants were randomly assigned to a treatment or wait-list control group before they underwent a cross-over of conditions. Treatment consisted of a 4-week iCBT with three face-to-face sessions. 60.9% of participants who received treatment completed all six modules. Intention-to-treat analysis showed treatment was associated with significant reductions in symptoms of depression, anxiety and psychological distress but not in functional impairment, while the control condition was not associated with changes in any measures. These reductions had moderate to large effect sizes (ESs) for symptoms of depression and anxiety, and moderate ES for psychological distress. The between-group difference in depression score had a moderate ES. There was a significant between-group treatment effect in depressive symptoms, but not in the other measures. Treatment gains were maintained at 3-month follow-up. Most of the participants were highly satisfied with the programme, with 90 percent stating they would recommend it. This is the first RCT to provide preliminary evidence for the efficacy and acceptability of iCBT for depression in Singapore.

Highlights

Depression is the leading cause of disability globally (Kessler et al, 2003, 2006)
Previous studies have shown that the barriers to accessing treatment in Asian populations include stigma, concerns about treatment costs, transportation difficulties and a Depression ICBT RCT, Singapore shortage of culturally appropriate services (Lu et al, 2013)
The present study aims to explore the efficacy and acceptability of a blended internet-based Cognitive Behavioural Therapy (iCBT) programme, with three face-to-face sessions conducted by a clinician, for patients with depression in Singapore

Summary

Introduction

Depression is highly comorbid with other mental and physical conditions and its presence exacerbates dysfunction, and burden on health services (Angst et al, 1999). It is estimated that 6.3% of Singaporeans will have depression and 1.6% will have anxiety at some point, with 3.5% suffering from at least two mental health disorders in their life (Subramaniam et al, 2020). Cognitive Behavioural Therapy (CBT) is a mainstay in evidence-based treatments for depression and anxiety. 59.6% of Singaporeans with depression do not access professional help (Chong et al, 2012). Previous studies have shown that the barriers to accessing treatment in Asian populations include stigma, concerns about treatment costs, transportation difficulties and a Depression ICBT RCT, Singapore shortage of culturally appropriate services (Lu et al, 2013). Access to psychotherapy may be limited during periods of emergency, as witnessed during the ongoing COVID19 pandemic where multiple countries have gone into lockdown and healthcare services have been restricted (Yang et al, 2020)

Methods

Results

Conclusion