Efficacy of computer- and/or internet-based cognitive-behavioral guided self-management for depression in adults and adolescents: a systematic review and meta-analysis of randomized controlled trials

Mamukashvili-Delau, Megi; Koburger, Nicole; Dietrich, Sandra; Rummel‐Kluge, Christine

doi:10.21203/rs.3.rs-1816188/v1

Cited by 2 publications

References 52 publications

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Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial

Rotondi,

Belnap,

Rothenberger

et al. 2024

JMIR Ment Health

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Background A previously reported study examined the treatment of primary care patients with at least moderate severity depressive or anxiety symptoms via an evidence-based computerized cognitive behavioral therapy (CCBT) program (Beating the Blues) and an online health community (OHC) that included a moderated internet support group. The 2 treatment arms proved to be equally successful at 6-month follow-up. Objective Although highly promising, e-mental health treatment programs have encountered high rates of noninitiation, poor adherence, and discontinuation. Identifying ways to counter these tendencies is critical for their success. To further explore these issues, this study identified the primary care patient characteristics that increased the chances patients would not initiate the use of an intervention, (ie, not try it even once), initiate use, and go on to discontinue or continue to use an intervention. Methods The study had 3 arms: one received access to CCBT (n=301); another received CCBT plus OHC (n=302), which included a moderated internet support group; and the third received usual care (n=101). Participants in the 2 active intervention arms of the study were grouped together for analyses of CCBT use (n=603) because both arms had access to CCBT, and there were no differences in outcomes between the 2 arms. Analyses of OHC use were based on 302 participants who were randomized to that arm. Results Several baseline patient characteristics were associated with failure to initiate the use of CCBT, including having worse physical health (measured by the Short Form Health Survey Physical Components Score, P=.01), more interference from pain (by the Patient-Reported Outcomes Measurement Information System Pain Interference score, P=.048), less formal education (P=.02), and being African American or another US minority group (P=.006). Characteristics associated with failure to initiate use of the OHC were better mental health (by the Short Form Health Survey Mental Components Score, P=.04), lower use of the internet (P=.005), and less formal education (P=.001). Those who initiated the use of the CCBT program but went on to complete less of the program had less formal education (P=.01) and lower severity of anxiety symptoms (P=.03). Conclusions This study found that several patient characteristics predicted whether a patient was likely to not initiate use or discontinue the use of CCBT or OHC. These findings have clear implications for actionable areas that can be targeted during initial and ongoing engagement activities designed to increase patient buy-in, as well as increase subsequent use and the resulting success of eHealth programs. Trial Registration ClinicalTrials.gov NCT01482806; https://clinicaltrials.gov/study/NCT01482806

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Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial

Rotondi,

Belnap,

Rothenberger

et al. 2024

JMIR Ment Health

View full text Add to dashboard Cite

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Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial (Preprint)

Rotondi,

Belnap,

Rothenberger

et al. 2023

Preprint

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BACKGROUND A previously reported study examined the treatment of primary care patients with at least moderate severity depressive and/or anxiety symptoms via Beating the Blues, an evidence-based computerized cognitive behavioral therapy program (CCBT), or CCBT and an Online Health Community (OHC) that included a moderated Internet support group (ISG). The two treatment arms proved to be equally successful at 6-month follow-up. OBJECTIVE Though highly promising, e-mental health treatment programs have encountered high rates of non-initiation, poor adherence, and discontinuation. Identifying ways to counter these tendencies is critical to their success. To further explore these issues, this study identified the primary care patient characteristics that increased the chances patients would: not initiate use of an intervention, that is, not try it even once; initiate use; and, go on to discontinue, or continue to use an intervention. METHODS The study had three arms: one received access to CCBT (n=301); another received CCBT plus the OHC (n=302), which included a moderated Internet Support Group; and the third received usual care (n=101). Participants in the two active intervention arms of the study were grouped together for analyses of CCBT utilization (n=603), because both arms had access to CCBT, and there were no differences in outcomes between the two arms. Analyses of the OHC utilization were based on the 302 participants who were randomized to that arm. RESULTS Several baseline patient characteristics were associated with failure to initiate use of CCBT, including, having worse physical health (measured by the SF-12 Physical Components Score, P=.012), more interference from pain (by the PROMIS Pain Interference score, P=.048), less formal education (P=.018), and being African American or other US minority group (P=.006). Characteristics associated with failure to initiate use of the OHC were, better mental health (by the SF-12 Mental Components Score, P=.04), lower use of the internet (P=.005), and less formal education (P=.001). Those who initiated use of the CCBT program but went on to complete less of the program, had less formal education (P=.013) and lower severity of anxiety symptoms (P=.029). CONCLUSIONS This study found that there were several patient characteristics that predicted whether a patient was likely to not initiate use, or discontinue use of the CCBT or OHC. These findings have clear implications for actionable areas that can be targeted during initial and on-going engagement activities designed to increase patient buy-in and subsequent utilization and resulting success of e-health programs. CLINICALTRIAL ClinicalTrials.gov identifier NCT01482806

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Efficacy of computer- and/or internet-based cognitive-behavioral guided self-management for depression in adults and adolescents: a systematic review and meta-analysis of randomized controlled trials

Cited by 2 publications

References 52 publications

Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial

Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial

Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial (Preprint)

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