No Health without Mental Health: European Clinical Psychology Takes Responsibility
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Internet- and mobile-based interventions

Session chair: Jacobi, Corinna, Professor (Technische Universität Dresden, Dresden, Germany)
 
Shortcut: S18
Date: Friday, 1 November, 2019, 11:45 a.m.
Room: Audi max
Session type: Symposia

Contents

11:45 a.m. S18-01

Effectiveness and cost-effectiveness of internet-delivered interventions for depression and anxiety disorders in the Improving Access to Psychological Therapies: results from a randomised control trial (#11)

D. Richards1, A. Enrique1, M. Franklin1, D. Duffy1, J. Palacios1, C. Earley1, L. Timulak1

1 E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland

Unstructured Abstract

Introduction. The present study assesses in a real-world setting the effectiveness and cost-effectiveness of internet-delivered interventions for depression at NHS IAPT.

Methods. This real-world, randomised control trial includes supported iCBT interventions for depression and anxiety disorders or 8-week waiting-list control. Primary clinical outcomes were depression (PHQ-9) and anxiety (GAD-7). For the CEA, the EQ-5D-5L (generic health status) and ReQoL-10 (mental well-being) were used to elicit the QALY using the area under the curve (AUC) method, with self-reported resource-use and costing from a healthcare payer perspective. Aforementioned data were collected at six time-points: baseline, 8-week, 3, 6, 9, and 12-month follow-up.

Results: Overall, 384 users were randomised to iCBT (n=256) or waiting-list control (n=128). For the CEA, two sets of results will be presented at the conference: (1) Presentation of effectiveness results from LMM across 12-months and (2) cost per QALY analysis of iCBT relative to waiting-list control accounting for data collection at six time-points across a 12-month period.

Conclusion: This study seeks to assess the effectiveness and cost-effectiveness of iCBT interventions for depression and anxiety that are integrated within step-2 of IAPT stepped-care model, and to compare it to a waiting list control. The results will provide a detailed analysis of how iCBT perform as an integrated treatment option within primary care settings. The study has the potential to show how iCBT can enhance service provision as a cost-effective treatment option and the findings will likely be generalisable to other health services.

Keywords: Depression, Anxiety, iCBT
12:00 p.m. S18-02

Telephone-based cognitive behavioural therapy (tel-CBT) for mild to moderate depression – results of the randomised-controlled TIDe-study (#134)

E. Haller1, T. Rosemann2, H. H. Koenig3, K. Wegscheider4, B. Watzke1

1 University of Zurich, Dep. of Clinical Psychology and Psychotherapy Research, Zurich, Switzerland
2 University of Zurich, Department of Primary Care, Zurich, Switzerland
3 University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Care Research, Hamburg, Germany
4 University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany

Structured Abstract

Cognitive behavioural therapy (CBT) is an evidence-based treatment for depression – however, patient-related factors and an insufficient integration in primary care impedes access to treatment. Telephone-based low-intensity treatments can help overcome barriers by providing a timely, adequate and accessible therapy with an emphasis on guided self-help.

TIDe (telephone-intervention for depression) is a randomised-controlled trial examining the effectiveness and cost-effectiveness of tel-CBT compared to treatment as usual in routine care. Primary and secondary outcomes include symptom change (PHQ-9), response, remission, health-related quality of life (SF-12; EQ-5D-5L), depression-related self-efficacy, and are assessed at baseline, at the end of treatment (t1) and 12 months after baseline (t2).

A total of 54 patients were self-referred or recruited by GPs and subsequently randomised to either intervention group (nIG = 29) or control group (nCG = 25).. Baseline-adjusted one-way ANCOVA revealed a reduction of mean difference of 2.1 on the PHQ-9 between IG and CG post treatment with moderate effect size (η2 = .074) without being statistically significant (p> .05). In the IG, patients 25% experienced a reliable and clinically significant symptom change compared to 13,9% in the CG.

The results of the RCT demonstrate a positive impact of Tel-CBT compared to treatment as usual in primary care with moderate effect size in the primary outcome.  However, due to the small sample size the comparison in the primary outcome is not statistically significant. The lack of statistical power underlines the difficulty of patient recruitment in routine care despite a relatively high treatment satisfaction and acceptance amongst patients. Given the findings and the high prevalence of depression in primary care, it is deemed important to improve the integration of accessible, evidence-based depression treatment in primary care.

Keywords: Depression, low intensity CBT, telephone, primary care
12:15 p.m. S18-03

Med-Stress: Resource-Oriented Internet Intervention Dedicated to Medical Professionals Reduces Depression and Job-Related Traumatic Stress (#87)

E. Smoktunowicz1, M. Lesnierowska1, R. Cieslak1, 2, P. Carlbring3, 4, G. Andersson5, 6

1 SWPS University of Social Sciences and Humanities, Department of Psychology, Warsaw, Poland
2 University of Colorado Colorado Springs, Trauma, Health, and Hazards Center, Colorado Springs, United States of America
3 Stockholm University, Department of Psychology, Stockholm, Sweden
4 University of Southern Denmark, Department of Psychology, Odense, Denmark
5 Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
6 Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden

Structured Abstract

The goal of this four-arm randomized controlled trial was to test the effectiveness of Med-
Stress intervention dedicated to medical professionals and aimed at improving their mental
health at work. Med-Stress is focused on strengthening self-efficacy and perceived social
support: two psychological resources that can operate individually or sequentially. In
accordance with the cultivation hypothesis, self-efficacy precedes perceived social support,
whereas enabling hypothesis proposes the reverse order.


Participants were randomized into one of four conditions: 1) self-efficacy and perceived
support sequential enhancement (experimental condition testing cultivation hypothesis), 2)
perceived social support and self-efficacy sequential enhancement (experimental condition
testing enabling hypothesis), 3) self-efficacy enhancement (active comparator), and 4)
perceived social support enhancement (active comparator). Out of 1240 participants that
completed surveys at the pre-test, 214 did so at the post-test. This paper reports on two
outcomes: depression and job-related traumatic stress. The analyses of covariance with the
baseline level of a respective outcome introduced as a covariant were carried out on the
intention-to-treat sample. Condition assignment had no significant effect on job-related
traumatic stress, F(3, 1235) = 2.21, p = .09, ηp² = 0.005, but it did on depression, F(3, 1235) =
11.85, p < .001, ηp² = 0.03: depression was lower in both experimental conditions than in an
active comparator dedicated to enhance only self-efficacy. Stress and depression at the posttest
decreased in all conditions compared to their baseline levels.


Med-Stress intervention was effective in decreasing depression and job-related traumatic
stress although our expectations regarding the differences between groups were only
partially confirmed. These results show only the effects immediately after the intervention
but will be supplemented with the those from the 6-month follow-up.

Keywords: Med-Stress, Depression, stress, internet-intervention
12:30 p.m. S18-04

Integrating technology into mental health care delivery in Europe: First results of the ICare collaborative project

C. Jacobi

Technische Universität Dresden, Professur Klinische Psychologie und E-Mental Health, Dresden, Germany

Introduction:

The evidence-base of Internet-based interventions in the prevention and treatment of mental health conditions has rapidly grown in the past decade. However, implementation of these approaches into European health systems varies largely among the different countries. ICare”, a large EU-Horizon 2020 collaborative project comprises 12 research institutions and one business enterprise in 6 countries in Europe (Germany, Austria, Switzerland, Great Britain, The Netherlands, Spain). The ICare consortium aims to establish a comprehensive model of health promotion, risk detection and disease prevention for the most prevalent mental health problems (depression, anxiety, adjustment disorders, eating disorders/weight management and substance abuse). We will summarize goals and first results of this 4-year project.

Methods

7 multi-country clinical trials (6 randomized controlled efficacy and effectiveness trials, one dissemination trial) were conducted including patients with common mental health disorders (CMHD), participants at risk for these, and carers. In the trials, tailored, evidence-based, online interventions covering universal, targeted prevention, self-help and treatment were provided for children, adolescents and adults.

Results

Overall, over 7.500 participants, patients and carers were recruited over the course of the project. Pre-post assessments of primary outcomes are completed in most trials. Significant reductions in risk factors, symptoms of CMHD, and improvements in resilience were observed in participants in 4 of the 7 trials. Results on health economic evaluations, moderators and mediators of interventions as well as secondary analyses are pending.

Conclusions

Our first results indicate that the ICare model could successfully been integrated into health care settings in the participating countries. However, acceptability, reach, and efficacy of the interventions vary among countries and sustained implementation strategies remain challenging.