Abstract
BackgroundWeb-based interventions for depression that are supported by coaching have generally produced larger effect-sizes, relative to standalone web-based interventions. This is likely due to the effect of coaching on adherence. We evaluated the efficacy of a manualized telephone coaching intervention (TeleCoach) aimed at improving adherence to a web-based intervention (moodManager), as well as the relationship between adherence and depressive symptom outcomes.Methods101 patients with MDD, recruited from primary care, were randomized to 12 weeks moodManager+TeleCoach, 12 weeks of self-directed moodManager, or 6 weeks of a waitlist control (WLC). Depressive symptom severity was measured using the PHQ-9.ResultsTeleCoach+moodManager, compared to self-directed moodManager, resulted in significantly greater numbers of login days (p = 0.01), greater time until last use (p = 0.007), greater use of lessons (p = 0.03), greater variety of interactive tools used (p = 0.02), but total instances of tool use did not reach statistical significance. (p = 0.07). TeleCoach+moodManager produced significantly lower PHQ-9 scores relative to WLC at week 6 (p = 0.04), but there were no other significant differences in PHQ-9 scores at weeks 6 or 12 (ps>0.20) across treatment arms. Baseline PHQ-9 scores were no significantly related to adherence to moodManager.ConclusionsTeleCoach produced significantly greater adherence to moodManager, relative to self-directed moodManager. TeleCoached moodManager produced greater reductions in depressive symptoms relative to WLC, however, there were no statistically significant differences relative to self-directed moodManager. While greater use was associated with better outcomes, most users in both TeleCoach and self-directed moodManager had dropped out of treatment by week 12. Even with telephone coaching, adherence to web-based interventions for depression remains a challenge. Methods of improving coaching models are discussed.Trial RegistrationClinicaltrials.gov NCT00719979
Highlights
The one-year prevalence rate of major depressive disorder (MDD) has been estimated between 6.6–10.3% in the general population [1,2], taking an enormous toll in terms of cost, morbidity, suffering, and mortality [3,4,5]
We have described a model of coaching, called ‘‘supportive accountability [14],’’ for behavioral intervention technologies (BITs), including web-based and mobile interventions
Participants Participants were recruited from July 2009 to February 2011 through the Northwestern University General Internal Medicine clinic via fliers in exam rooms, physician referral, and recruitment letters sent by postal mail to randomly selected clinic patients
Summary
The one-year prevalence rate of major depressive disorder (MDD) has been estimated between 6.6–10.3% in the general population [1,2], taking an enormous toll in terms of cost, morbidity, suffering, and mortality [3,4,5]. Trials of standalone web-based treatments have shown very weak effects, while treatments involving coach support have produced stronger results [9,10]. The weaker effects are likely due to the very high dropout rates and non-adherence seen in standalone treatments [11,12]. While trials of coached interventions have produced better adherence, dropout rates for web-based interventions remain higher for MDD than for other disorders [13]. Web-based interventions for depression that are supported by coaching have generally produced larger effect-sizes, relative to standalone web-based interventions. This is likely due to the effect of coaching on adherence. We evaluated the efficacy of a manualized telephone coaching intervention (TeleCoach) aimed at improving adherence to a web-based intervention (moodManager), as well as the relationship between adherence and depressive symptom outcomes
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