Abstract
BackgroundDespite the availability of evidence-based treatments for depression, a large proportion of patients remains untreated or adequate treatment is initiated with delay. This situation is particularly critical in primary care, where not only most individuals first seek help for their mental health problems, but also depressive disorders – particularly mild to moderate levels of severity – are highly prevalent given the high comorbidity of chronic somatic conditions and depression. Improving the access for evidence-based treatment, especially in primary care, is hence a priority challenge in the mental health care agenda. Telephone usage is widespread and has the potential of overcoming many barriers that individuals suffering from mental health problems are facing: Its implementation for treatment delivery presents an option for optimisation of treatment pathways and outcomes.Methods/designThis paper details the study protocol for a randomised controlled trial (RCT) evaluating the effectiveness of a telephone-administered short-term cognitive-behavioural therapy (T-CBT) for depression as compared to treatment as usual (TAU) in the Swiss primary care setting. The study aims at randomising a total of 216 mildly to moderately depressed patients, which are either identified by their General Practitioners (GPs) or who self-refer to the study programme in consultation with their GP. The trial will examine whether telephone-delivered, manualised treatment leads to clinically significant reduction in depression at follow-up. It will further investigate the cost-effectiveness and acceptability of the intervention in the primary care setting.DiscussionConducting a low-intensity treatment on the telephone allows for greater flexibility for both patient and therapist, can grant more anonymity and can thus lead to less hesitation in the patient about whether to attempt treatment or not. In order to benefit from this approach, large-scale studies need to prove superior effectiveness and cost-effectiveness of telephone-delivered therapy over routine care for patients with mild to moderate depression.Trial registrationClinicalTrials.gov NCT02667366. Registered on 3 December 2015.
Highlights
Despite the availability of evidence-based treatments for depression, a large proportion of patients remains untreated or adequate treatment is initiated with delay
Almost two thirds of patients suffering from mild depression and one third of patients suffering from moderate depression receive exclusively antidepressant medication [6], even though international guidelines recommend psychotherapy and low-intensity treatment – with a particular focus on cognitive-behavioural therapy (CBT) – as first-line treatment [8, 9]
Our study aims at evaluating the effectiveness of a telephone-delivered CBT as an add-on treatment to routine care in primary care patients with mild to moderate depression under clinically representative conditions
Summary
Despite the availability of evidence-based treatments for depression, a large proportion of patients remains untreated or adequate treatment is initiated with delay This situation is critical in primary care, where most individuals first seek help for their mental health problems, and depressive disorders – mild to moderate levels of severity – are highly prevalent given the high comorbidity of chronic somatic conditions and depression. Almost two thirds of patients suffering from mild depression and one third of patients suffering from moderate depression receive exclusively antidepressant medication [6], even though international guidelines recommend psychotherapy and low-intensity treatment – with a particular focus on cognitive-behavioural therapy (CBT) – as first-line treatment [8, 9] These clinical guidelines further explicitly advise against the application of antidepressant medication in mild degrees of severity except for special situations, due to the unfavourable risk-benefit ratio with regard to undesirable side effects. Treatments that are not compliant to clinical guidelines present a serious problem for patients suffering from less severe depressive disorders
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