Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 1, 2019
Date Accepted: Apr 21, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Scheduled telephone support improves adherence to and outcomes of internet cognitive behavioral therapy for depression in patients at risk for drop-out: a pragmatic randomized controlled trial
ABSTRACT
Background:
Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficient in the treatment of depression. The optimal mode and intensity of therapist support remain, however, to be identified. Scheduled Telephone Support (STS) may improve adherence and outcomes but, as time- and resource consuming, should be reserved for patients for whom the usual support may be insufficient.
Objective:
To reveal whether add-on STS for patients at risk of dropping out improves treatment adherence and symptoms in iCBT for depression.
Methods:
Among patients participating in an on-going large observational, routine clinical-practice study of iCBT for depression that was delivered nationwide by Helsinki University Hospital (HUS-iCBT), those demonstrating a ≥14-day delay in initiation of treatment received invitations to this subsidiary STS study. One hundred consenting patients we randomly allocated to either HUS-iCBT (n=50) or HUS-iCBT plus STS (n=50). Proportions of those reaching mid-treatment and treatment endpoint served as the primary outcome; secondary outcomes were change in Beck Depression Inventory (BDI)-measured depressive symptoms and time spent in treatment.
Results:
STS raised the proportion of patients reaching mid-treatment (58% vs. 36% for the control group, p=.013) and endpoint (24% vs. 6%, p=.009). Change in BDI score also favored add-on STS (4.3 points vs. 1.1 points for the control group, p=0.013), whereas lengths of time in treatment did not differ.
Conclusions:
Add-on STS enhances adherence and symptom improvement of patients at risk of dropping out of iCBT for depression in routine clinical practice.
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