Abstract
BackgroundDepression is a common mental disorder with a high social burden and significant impact on suicidality and quality of life. Treatment is often limited to drug therapies because of long waiting times to see psychological therapists face to face, despite several guidelines recommending that psychological treatments should be first-line interventions for mild to moderate depression.ObjectiveWe aimed to evaluate, among patients on a waitlist to receive secondary mental health care services for depression, how effective coach-guided web-based therapy (The Journal) is, compared with an information-only waitlist control group, in reducing depression symptoms after 12 weeks.MethodsWe conducted a randomized controlled trial with 2 parallel arms and a process evaluation, which included interviews with study participants. Participants assigned to the intervention group received 12 weeks of web-based therapy guided by a coach who had a background in social work. Patients in the control group receive a leaflet of mental health resources they could access. The primary outcome measure was a change in depression scores, as measured by the Patient-Health Questionnaire (PHQ-9).ResultsA total of 95 participants were enrolled (intervention, n=47; control, n=48). The mean change in PHQ-9 scores from baseline to week 12 was −3.6 (SD 6.6) in the intervention group and −3.1 (SD 6.2) in the control group, which was not a statistically significant difference with a two-sided alpha of .05 (t91=−0.37; P=.72, 95% CI −3.1 to 2.2). At 12 weeks, participants in the intervention group reported higher health-related quality of life (mean EuroQol 5 dimensions visual analogue scale [EQ-5D-VAS] score 66.8, SD 18.0) compared with the control group (mean EQ-5D VAS score 55.9, SD 19.2; t84=−2.73; P=.01). There were no statistically significant differences between the two groups in health service use following their initial consultation with a psychiatrist. The process evaluation showed that participants in the intervention group completed a mean of 5.0 (SD 2.3) lessons in The Journal and 8.8 (SD 3.1) sessions with the coach. Most participants (29/47, 62%) in the intervention group who completed the full dose of the intervention, by finishing 6 or more lessons in The Journal, were more likely to have a clinically important reduction in depressive symptoms at 12 weeks compared with the control group (Χ21=6.3; P=.01, Φ=0.37). Participants who completed the interviews reported that the role played by the coach was a major factor in adherence to the study intervention.ConclusionsThe results demonstrate that the use of guided web-based therapy for the treatment of depression is not more effective than information-only waitlist control. However, it showed that the coach has the potential to increase adherence and engagement with web-based depression treatment protocols. Further research is needed on what makes the coach effective.Trial RegistrationClinicalTrials.gov: NCT02423733; https://clinicaltrials.gov/ct2/show/NCT02423733
Highlights
BackgroundDepression is a common mental disorder [1] with a high social burden [2] and significant impact on suicidality [3] and quality of life
We have previously reported on an randomized controlled trial. REEACT (RCT) of The Journal comparing guided web-based therapy with an information-only waitlist control in patients with depression referred to secondary mental health services in New Zealand [22]
We report on an RCT of The Journal [23], facilitated by a coach, compared with an information-only waitlist control group for the treatment of depression in patients referred to secondary mental health services in Canada
Summary
BackgroundDepression is a common mental disorder [1] with a high social burden [2] and significant impact on suicidality [3] and quality of life. Treatment is often limited to drug therapies, in part, due to long waiting lists to see psychological therapists face-to-face. This is contrary to recommendations about the importance of nondrug therapies by the National Institute for Health and Care Excellence (NICE), based in the United Kingdom, and other institutions [4]. In secondary and tertiary mental health care centers in Ontario, at the time of this trial, the waiting time to be seen by a psychiatrist for depression was between 9 months and 1 year. Treatment is often limited to drug therapies because of long waiting times to see psychological therapists face to face, despite several guidelines recommending that psychological treatments should be first-line interventions for mild to moderate depression
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