Stepped Telemental Health Care Intervention for Depression
| Status: | Completed |
|---|---|
| Conditions: | Depression, Depression |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/24/2018 |
| Start Date: | February 2015 |
| End Date: | April 2018 |
This is a randomized, controlled trial comparing telephone-cognitive behavior therapy (T-CBT)
with a therapist to a "Stepped Care" intervention for depression treatment (iCBT with support
from a telephone coach with the possibility of being stepped up to receiving T-CBT with a
therapist).
with a therapist to a "Stepped Care" intervention for depression treatment (iCBT with support
from a telephone coach with the possibility of being stepped up to receiving T-CBT with a
therapist).
Major depressive disorder (MDD) is common, with 12-month prevalence rates estimated to be
between 6.6-10.3%. While many depressed patients state they would prefer psychological
treatment to pharmacotherapy, substantial barriers to care exist, including cost, practical
barriers such as time constraints and transportation, emotional barriers such as stigma,
decreased motivation associated with depression itself, physical disability, and lack of
availability of services. Telemental health has been proposed as a method of overcoming
barriers to treatment. Research has focused primarily on two formats: the telephone and the
Internet. Use of the telephone as a delivery medium produces reductions in depression
equivalent to face-to-face psychological treatments, while also significantly reducing
attrition. However, its success in outreach can also significantly increase costs for
healthcare providing organizations. Internet interventions have the potential to produce
moderate gains when supported by therapist or coach via brief telephone calls or e-mail but
are also less expensive than standard therapy. Developing healthcare models that integrate
treatment delivery media holds the promise of harnessing the advantages of each media, while
minimizing the disadvantages. Stepped care models are a potentially useful framework for
achieving such an integration. The stepped care model we will test initiates treatment with a
validated, guided Internet cognitive behavioral therapy program. If patients fail to respond,
they will be stepped up to a validated telephone-cognitive behavior therapy (T-CBT). The
stepped care model will be compared to T-CBT in a randomized trial. Patients will be
recruited from primary care and treated for up to 20 weeks, or until sustained remission is
achieved.
between 6.6-10.3%. While many depressed patients state they would prefer psychological
treatment to pharmacotherapy, substantial barriers to care exist, including cost, practical
barriers such as time constraints and transportation, emotional barriers such as stigma,
decreased motivation associated with depression itself, physical disability, and lack of
availability of services. Telemental health has been proposed as a method of overcoming
barriers to treatment. Research has focused primarily on two formats: the telephone and the
Internet. Use of the telephone as a delivery medium produces reductions in depression
equivalent to face-to-face psychological treatments, while also significantly reducing
attrition. However, its success in outreach can also significantly increase costs for
healthcare providing organizations. Internet interventions have the potential to produce
moderate gains when supported by therapist or coach via brief telephone calls or e-mail but
are also less expensive than standard therapy. Developing healthcare models that integrate
treatment delivery media holds the promise of harnessing the advantages of each media, while
minimizing the disadvantages. Stepped care models are a potentially useful framework for
achieving such an integration. The stepped care model we will test initiates treatment with a
validated, guided Internet cognitive behavioral therapy program. If patients fail to respond,
they will be stepped up to a validated telephone-cognitive behavior therapy (T-CBT). The
stepped care model will be compared to T-CBT in a randomized trial. Patients will be
recruited from primary care and treated for up to 20 weeks, or until sustained remission is
achieved.
Inclusion Criteria:
- Has a DSM-IV diagnosis of non-psychotic major depressive disorder (MDD) as assessed
using the Mini International Neuropsychiatric Interview (MINI), plus a score of 12 or
greater on the Quick Inventory of Depressive Symptomatology - Clinician Rated (QIDS-C)
- Has a phone, access to the Internet, and basic internet skills
- Is at least 18 years of age
- Is able to speak and read English
- If currently taking an antidepressant medication, participant must have been on a
stable dose for at least two weeks, and have no plans to change the dose
Exclusion Criteria:
- Has visual, hearing, voice, or motor impairment that would prevent completion of study
procedures
- Is diagnosed with a psychotic disorder, bipolar disorder, dissociative disorder,
substance use or other diagnosis for which participation in this trial is either
inappropriate or dangerous
- Is severely suicidal (has ideation, plan, and intent)
- Is currently receiving or planning to begin psychotherapy during the study treatment
period
We found this trial at
1
site
Click here to add this to my saved trials
