An Exploratory Brief Head-To-Head Non-Inferiority Comparison of an Internet-Based and a Telephone-Delivered CBT Intervention for Adults with Depression

Evaluating the Efficacy of Telehealth-Based Treatments for Depression in Adults: A Rapid Review and Meta-Analysis

PURPOSE

Major depressive disorder (MDD) is one of the leading causes of work-related disability, and accessing telehealth therapies can be a promising modality for workers with MDD. Barriers to accessing in-person mental healthcare, such as limited availability and accessibility in rural and remote communities, financial constraints, and stigma, have highlighted the need for alternative approaches like telehealth. This study investigated the efficacy of telehealth interventions including CBT for adults over 18 diagnosed with MDD.

METHODS

This rapid review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a transparent methodology. Out of the 2549 studies screened, 19 were incorporated into the rapid review, and of those, 10 were included in the subsequent meta-analyses. Articles were screened independently by two reviewers, with the disagreements reconciled through discussion. A reviewer extracted data from eligible articles. Descriptive statistics and narrative syntheses were used to describe outcomes. Two meta-analyses were conducted to investigate the efficacy of cognitive behavioral therapy (CBT) delivered by telehealth (tCBT). The first compared tCBT to in-person CBT (pCBT). The second meta-analysis compared tCBT to a control group that did not receive CBT or another telehealth-based treatment. Non-CBT interventions investigated within the non-CBT group included somatic rhythm therapy, problem-solving therapy, psychiatry, behavioral activation, and interpersonal psychotherapy.

RESULTS

Overall, individuals with MDD who received tCBT showed significant improvement in depression symptoms. However, the efficacy of tCBT compared to non-telehealth control groups varied across studies. The first meta-analysis indicated the magnitudes of effect were similar for both interventions in reducing depression symptoms 0.023 (95% CI - 0.120 to 0.166); p = 1.00. In the second meta-analysis, the ratio of means comparing tCBT (0.51 ± 0.14 SD) to the control group (0.68 ± 0.12 SD) exhibited a statistically significant 25% reduction with regard to depression scores (one-sided p = 0.002), favouring tCBT to non-telehealth, non-CBT study groups.

CONCLUSIONS

Telehealth-based CBT demonstrated positive effects on depression symptoms; it was generally superior when compared to control groups not receiving CBT and was on par with pCBT. The growing mental health burden in the community underscores the need for accessible telehealth services like tCBT. Effective policy formulation and implementation in national health agendas are essential to meet the increasing demand for mental health support.

The efficacy of telephone-delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta-analysis

COVID-19 pandemic led to an increase of remote treatments, such as telephone-delivery cognitive behavioral therapy (T-CBT). To our knowledge, no meta-analyses studied the effect of T-CBT in chronic and/or mental illnesses on multiple psychological outcomes. Therefore, our study aims to evaluating the efficacy of T-CBT compared to other interventions (treatment as usual, TAU, or face-to-face CBT). Each effect size (ES) was calculated in Hedges' g and pooled together to produce a mean ES for each outcome (depression, anxiety, mental and physical QoL, worry, coping, and sleep disturbances). The meta-analysis included 33 studies with a randomized controlled trial design. A large ES was found when comparing the efficacy of T-CBT against TAU on depression (g = 0.84, p < 0.001), whereas a moderate ES was found on anxiety (g = 0.57; p < 0.001), and a small effect on mental quality of life (g = 0.33, p < 0.001), sleep disturbances (g = 0.37, p = 0.042), coping (g = 0.20, p = 0.016) and worry (g = 0.43, p = 0.001). The meta-analysis comparing the efficacy of T-CBT and CBT on depression revealed a not significant pooled ES (g = 0.06, p = 0.466). The results provided evidence that T-CBT could be to be more effective than TAU conditions in multiple psychological outcomes, and as efficient as face-to-face CBT in treating depression.

COVID-19 related differences in the uptake and effects of internet-based cognitive behavioural therapy for symptoms of obsessive-compulsive disorder

BACKGROUND

The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated.

AIM

This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year.

METHOD

1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) pre- and post-treatment.

RESULTS

During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinician-guided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65-0.68) and depression symptom severity (g = 0.56-0.65), medium to large reductions in psychological distress (g = 0.77-0.83) and small reductions in disability (g = 0.35-.50).

CONCLUSION

Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services.

The effect of depression and anxiety symptom severity on clinical outcomes and app use in digital mental health treatments: Meta-regression of three trials

A large number of trials have consistently shown that guided digital mental health treatments (DMHTs) are effective for depression and anxiety. As DMHTs are adopted by healthcare organizations, payers, and employers, they are often considered most appropriate for people with mild-to-moderate levels of symptom severity. Thus, the aim of this study was to examine the effects of symptom severity on depression and anxiety outcomes and app use across three trials of a guided DMHT, IntelliCare. Participants were categorized into mild, moderate, moderately severe, and severe symptom severity groups on depression and anxiety. All symptom severity groups showed significant reductions in depression and anxiety in a clear ordinal pattern, with the mild symptom severity group showing the smallest changes and the severe symptom group showing the largest improvements. Those with the lowest levels of educational attainment showed the largest symptom improvement. Baseline symptom severity was not significantly related to app use. App use was significantly related to depression and anxiety outcomes. These findings suggest that depression and anxiety symptom severity is not useful in determining who should be referred to a guided DMHT.