JMIR Publications

ABSTRACT

Background:

The prevalence of depressive and anxiety symptoms in patients with coronavirus disease 2019 (COVID-19) is higher than usual. Previous study showed that there are drug-drug interactions between antiretroviral drugs and antidepressants. Therefore, an effective and safe treatment method was urgently needed. Cognitive Behavior Therapy (CBT) is the first-line psychological treatment recommended by the guidelines of depression and anxiety. Computerized CBT (cCBT) was proved to be an effective alternative to CBT and no need for face-to-face therapy between therapist and patient, which was suitable during the COVID-19 epidemic.

Objective:

To evaluate the efficacy of the cCBT program we developed in improving the depressive and anxiety symptoms among patients with COVID-19.

Methods:

We customized a cCBT program focused on improving depressive and anxiety symptoms among the patients with COVID-19 and then assessed its effectiveness. Screening was based on depressive and/or anxiety symptoms, within 17 items Hamilton Depression Rating Scale (HAMD17) score≥7, and/or Hamilton Anxiety Scale (HAMA)score≥7. The total of 252 patients with COVID-19 at 5 sites were randomized into 2 groups: cCBT+ treatment as usual (TAU) (n = 126) and TAU (n =126), while the cCBT+TAU group received the cCBT intervention program for 1 week. The primary efficacy measures were HAMD17 and HAMA scores. The second outcome measures were Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Athens Insomnia Scale (AIS). Assessments were carried out at pre- and post-intervention. The depressive and anxiety symptoms of patients in one of the centers were assessed again within 1 month after post-intervention.

Results:

The cCBT+TAU group displayed significant reduction in scores on the HAMD17, HAMA, SDS, SAS and AIS compared to that in the TAU group (all P < .001). And a mixed-effects repeated-measures model revealed significant improvement in depressive (HAMD17 and SDS score), anxiety (HAMA and SAS score) and insomnia symptoms (AIS score) during the post-intervention and follow-up periods in the cCBT+TAU group (all P < .001). Additionally, the remission of insomnia symptom among female and middle school educated population in CCBT+TAU group have no significant difference compared to TAU group (both P > .05).

Conclusions:

The findings of this study implied that the cCBT program we developed was an effective nonpharmacologic treatment for depressive, anxiety, and insomnia symptoms among patients with COVID-19. And further research is warranted to investigate the long-term effects of cCBT for depressive, anxiety, and insomnia symptoms in patients with COVID-19. Clinical Trial: Chinese Clinical Trial Registry Number: ChiCTR2000030084.