Blended vs. face-to-face cognitive behavioural treatment for major depression in specialized mental health care: study protocol of a randomized controlled cost-effectiveness trial

Individuals experiencing psychosis have been described as one of the most stigmatised, disadvantaged and socially excluded groups in modern societies. Despite the development of evidence-based psychological treatments for psychosis, the access to such intervention remains debateable. In metropolitan areas, where clinical caseloads of mental health services should reflect the ethnic diversity of local populations, equal provision of recommended therapies might be further confounded, while empirical literature investigating this appears limited. The present study inspects equality of access to cognitive behavioural therapy for psychosis across four specialist healthcare teams located in Greater London. Subsequent acceptance and participation in treatment are also examined. A retrospective analysis of electronic medical records of 244 patients was conducted using binary logistic regression and multiple linear regression. Participants were shown to have received treatment offers equally across demographic variables. Likewise, once the treatment commenced, engagement was equally distributed. However, despite having equal access to the offered treatment, patients of Black ethnic group seemed less likely to accept such offer, hence appeared disadvantaged in terms of treatment provision. This study demonstrates that, in multicultural communities, equal access to core interventions for psychosis is achievable, however does not on its own merits ensure equitable treatment provision. Thus mental health services need to proactively focus on specific ethnic groups requiring further efforts to increase treatment uptake. Keywords: mental health, psychosis, cognitive behavioural treatment, diversity, equal access to healthcare

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Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week randomised controlled trial with 1-year follow-up

PLoS ONE ◽

10.1371/journal.pone.0259493 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259493

Author(s):

Geke Romijn ◽

Neeltje Batelaan ◽

Jeroen Koning ◽

Anton van Balkom ◽

Aart de Leeuw ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Cost Effectiveness ◽

Anxiety Disorders ◽

Behavioural Therapy ◽

Face To Face ◽

Point Estimates ◽

Cognitive Behavioural ◽

One Year

Background Anxiety disorders are highly prevalent and cause substantial economic burden. Blended cognitive-behavioural therapy (bCBT), which integrates Internet-based CBT and face-to-face CBT (ftfCBT), is an attractive and potentially cost-saving treatment alternative to conventional CBT for patients with anxiety disorders in specialised mental health care. However, little is known about the effectiveness of bCBT in routine care. We examined the acceptability, effectiveness and cost-effectiveness of bCBT versus ftfCBT in outpatient specialised care to patients with panic disorder, social anxiety disorder and generalised anxiety disorder. Methods and findings Patients with anxiety disorders were randomised to bCBT (n = 52) or ftfCBT (n = 62). Acceptability of bCBT and ftfCBT were evaluated by assessing treatment preference, adherence, satisfaction and therapeutic alliance. Costs and effects were assessed at post-treatment and one-year follow-up. Primary outcome measure was the Beck Anxiety Inventory (BAI). Secondary outcomes were depressive symptoms, general psychopathology, work and social adjustment, quality of life and mastery. Incremental cost-effectiveness ratios (ICERs) were computed from societal and healthcare perspectives by calculating the incremental costs per incremental quality-adjusted life year (QALY). No significant differences between bCBT and ftfCBT were found on acceptability or effectiveness measures at post-treatment (Cohen’s d between-group effect size on BAI = 0.15, 95% CI −0.30 to 0.60) or at one-year follow-up (d = −0.38, 95% CI −0.84 to 0.09). The modelled point estimates of societal costs (bCBT €10945, ftfCBT €10937) were higher and modelled point estimates of direct medical costs (bCBT €3748, ftfCBT €3841) were lower in bCBT. The acceptability curves showed that bCBT was expected to be a cost-effective intervention. Results should be carefully interpreted due to the small sample size. Conclusions bCBT appears an acceptable, clinically effective and potentially cost-saving alternative option for treating patients with anxiety disorders. Trials with larger samples are needed to further investigate cost-effectiveness. Trial registration Netherlands Trial Register: NTR4912.

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Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care (Preprint)

10.2196/preprints.12793 ◽

2018 ◽

Author(s):

Susan Fletcher ◽

Janine Clarke ◽

Samineh Sanatkar ◽

Peter Baldwin ◽

Jane Gunn ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

General Practice ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Web Based ◽

Recruitment Methods ◽

Face To Face ◽

Randomized Controlled

BACKGROUND E-mental health (eMH) interventions are now widely available and they have the potential to revolutionize the way that health care is delivered. As most health care is currently delivered by primary care, there is enormous potential for eMH interventions to support, or in some cases substitute, services currently delivered face to face in the community setting. However, randomized trials of eMH interventions have tended to recruit participants using online recruitment methods. Consequently, it is difficult to know whether participants who are recruited online differ from those who attend primary care. OBJECTIVE This paper aimed to document the experience of recruiting to an eMH trial through primary care and compare the characteristics of participants recruited through this and other recruitment methods. METHODS Recruitment to the SpringboarD randomized controlled trial was initially focused on general practices in 2 states of Australia. Over 15 months, we employed a comprehensive approach to engaging practice staff and supporting them to recruit patients, including face-to-face site visits, regular contact via telephone and trial newsletters, and development of a Web-based patient registration portal. Nevertheless, it became apparent that these efforts would not yield the required sample size, and we therefore supplemented recruitment through national online advertising and promoted the study through existing networks. Baseline characteristics of participants recruited to the trial through general practice, online, or other sources were compared using the analysis of variance and chi square tests. RESULTS Between November 2015 and October 2017, 780 people enrolled in SpringboarD, of whom 740 provided information on the recruitment source. Of these, only 24 were recruited through general practice, whereas 520 were recruited online and 196 through existing networks. Key barriers to general practice recruitment included perceived mismatch between trial design and diabetes population, prioritization of acute health issues, and disruptions posed by events at the practice and community level. Participants recruited through the 3 different approaches differed in age, gender, employment status, depressive symptoms, and diabetes distress, with online participants being distinguished from those recruited through general practice or other sources. However, most differences reached only a small effect size and are unlikely to be of clinical importance. CONCLUSIONS Time, labor, and cost-intensive efforts did not translate into successful recruitment through general practice in this instance, with barriers identified at several different levels. Online recruitment yielded more participants, who were broadly similar to those recruited via general practice.

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