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Clinical trial examines online care for mood, anxiety disorders in primary care

November 08, 2017

Bottom Line: For primary care patients with depression or anxiety, providing an online computerized cognitive behavioral therapy (CCBT) program through a collaborative care program was more effective than primary care physicians' usual care for these conditions. However, adding moderated access to an internet support group (ISG) provided no additional benefit over the CCBT program alone.

Why The Research Is Interesting: Previous research has shown the effectiveness of collaborative care - typically involving a nonphysician care manager who monitors patients under the supervision of a physician - for treating mood and anxiety disorders in primary care. CCBT has been used in Europe and Australia but it is little used in the United States. The effectiveness of internet support groups also has not been established.

Who and What: 704 patients with depression or anxiety from primary care practices in Pittsburgh randomized to CCBT, CCBT and ISG, or usual care as follows:

Mental health-related quality of life, as well as depression and anxiety symptoms, after six months were measured.

How (Study Design): This was a randomized clinical trial (RCT), which allows for the strongest inferences to be made about the true effect of an intervention. However, not all RCT results can be replicated in real-world settings because patient characteristics or other factors may differ from those that were studied in the RCT.
-end-
Authors: Bruce L. Rollman, M.D., M.P.H., of the University of Pittsburgh School of Medicine, and coauthors.

Results: After six months, patients who received CCBT and had access to an internet support group reported similar improvements in mental health-related quality of life, mood and anxiety symptoms as patients who had CCBT alone. Patients who had CCBT alone reported better improvements in mood and anxiety than those patients who received usual care.

Study Limitations: Researchers relied on one CCBT program and one internet support group for this study, so other programs and levels of human support may have different outcomes.

Study Conclusions: The internet support group in this study did not produce additional benefit over CCBT alone for patients in primary care with depression or anxiety but CCBT as part of a collaborative care program was more effective than usual care. The study focuses further attention on the emerging field of e-mental health.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/ jamapsychiatry.2017.3379)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

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