JMIR Publications

ABSTRACT

Background:

Depression is a hidden burden and yet, it is a leading cause of disability worldwide. Despite the adverse effects of depression, fewer than one-third of patients receive care. Electronically delivered cognitive behavioral therapy (e-CBT) is an effective treatment for depression and combining e-CBT with supervised care could make therapy scalable and effective. A stepped care model is a framework for beginning treatment with an effective and low-intensity intervention while adapting care based on the patient’s needs.

Objective:

This study investigated the efficacy of a stepped care e-CBT model for depression through changes in self-reported depressive symptoms.

Methods:

In this single-blinded randomized controlled trial, participants were allocated to either the e-CBT only group (n = 28) or the e-CBT with stepped care group (n = 28). Both groups received a 13-week e-CBT program tailored to depression. The e-CBT program was provided through a secure, online mental health clinic called the Online Psychotherapy Tool (OPTT). Participants read through the sessions and completed assignments related to each session. Participants in the stepped care group received additional interventions from their care provider based on standard questionnaire scores (i.e., PHQ-9, QIDS, Q-LES-Q), and their assignment responses. From lowest to highest intensity, the additional interventions included messages, phone calls, video calls, or a video call with a psychiatrist.

Results:

For this study, 56 participants were recruited to complete an e-CBT program (mean age = 38.9, 26.9% male) or an e-CBT with stepped care program (mean age = 40.6, 42.4% male). The results of this study indicate that the e-CBT program was effective in significantly reducing depressive symptoms, as measured by the PHQ-9 ((F(4, 80) = 9.95, P < .001)) and QIDS (F(2, 28) = 5.73, P = .008); however, there were no significant differences in the reduction of depressive symptoms between the two groups (PHQ-9: (F(4, 80) = 0.43, P = .785); QIDS: (F(2, 28) = 3.05, P = .063)). The stepped care group was not significantly better in reducing depressive symptoms than the e-CBT group. Although there were no significant differences observed between the number of participants who completed the program between groups [χ(1) = 2.62, P = .105], participants in the stepped care group, on average, took part in more sessions than those who prematurely terminated participation in the e-CBT group [t(55) = -2.00, P = .025, 95% CI = -4.83 to -.002].

Conclusions:

Implementing a stepped care approach into e-CBT is an effective treatment for depression and the stepped care model can assist patients to complete more sessions in their treatment. Clinical Trial: The research study was registered at ClinicalTrial.gov (NCT04747873).