JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic highlighted a critical need for effective population mental health approaches to target the most prevalent disorders, such as depression, during periods of elevated community distress. Studies investigating the effectiveness of remotely-delivered and web-based interventions are needed to identify and innovate high-quality models for population mental health service delivery.

Objective:

To compare the effectiveness of two transdiagnostic treatments, Mindfulness-Based Cognitive Therapy for Resilience (MBCT-R; remotely-delivered) and iCBT (web-based), with a low-intensity control condition, CHAMindWell (CHA-MW), a web-based population health screening and stratified support program, on depression symptom severity.

Methods:

Participants (N=97) were randomized in a 2:2:1 ratio to MBCT-R + CHA-MW (n=37), iCBT + CHA-MW (n=41), or CHA-MW alone (n=19) in a comparative effectiveness trial occurring from May 2021 to February 2023 in an urban public safety net hospital setting. MBCT-R was an 8-session, synchronous, online group curriculum that integrated mindfulness training and cognitive behavioral therapy to address COVID-19-related psychosocial stressors associated with increased risk for depression. iCBT was a 6-session, asynchronous, individual cognitive-behavioral therapy online curriculum for depression and anxiety. Both programs were supported by and compared with CHA-MW, an integrated web-based population health monitoring and response program. MBCT-R + CHA-MW and iCBT + CHA-MW were roughly time and attention matched, while CHA-MW alone was employed as a low-intensity control condition. All study procedures, including regular mental health symptom screenings, were conducted remotely or via a web-based platform. The primary outcome was change in depression symptom severity during the 24-week study period using an intention-to-treat approach that employed generalized linear mixed effects models to evaluate the comparative effectiveness of the three intervention arms over time. Secondary and exploratory outcomes included mental health clinician visits used during the 24-week study period as well as changes in anxiety, perceived stress, interoception, experiential avoidance, emotional dysregulation, self-compassion, and decentering.

Results:

For the primary outcome, results indicated significant reductions in depression symptom severity across all treatment arms (MBCT-R mean difference=-14.1 (95% CI [-21,-7.2]; iCBT mean difference=-12.7 (95% CI [-17.4, -8.1], CHA-MW mean difference=-15.2 (95% CI [-21.8, -8.6]) but no statistically significant between-group differences. For the secondary outcome, findings indicated no statistically significant differences in mental health clinician visits by group. Exploratory analyses demonstrated statistically significant improvement in mental health outcomes across all treatment arms with no significant between-group differences.

Conclusions:

This study demonstrated moderate to large effect size improvements in depression and exploratory mental health outcomes. However, it did not identify the superiority of any intervention, suggesting that CHA-MW, a low-intensity, resource-efficient, web-based, population mental health program, is a promising approach to mental wellness during times of high community distress with or without additional higher intensity remote interventions. Clinical Trial: NCT04595084