Effectiveness and cost-effectiveness of telephone-based cognitive-behavioural therapy in primary care: study protocol of TIDe – telephone intervention for depression

Abstract

BackgroundDespite the availability of evidence-based treatments for depression, a large proportion of patients remains untreated or adequate treatment is initiated with delay. This situation is particularly critical in primary care, where not only most individuals first seek help for their mental health problems, but also depressive disorders – particularly mild to moderate levels of severity – are highly prevalent given the high comorbidity of chronic somatic conditions and depression. Improving the access for evidence-based treatment, especially in primary care, is hence a priority challenge in the mental health care agenda. Telephone usage is widespread and has the potential of overcoming many barriers that individuals suffering from mental health problems are facing: Its implementation for treatment delivery presents an option for optimisation of treatment pathways and outcomes.Methods/designThis paper details the study protocol for a randomised controlled trial (RCT) evaluating the effectiveness of a telephone-administered short-term cognitive-behavioural therapy (T-CBT) for depression as compared to treatment as usual (TAU) in the Swiss primary care setting. The study aims at randomising a total of 216 mildly to moderately depressed patients, which are either identified by their General Practitioners (GPs) or who self-refer to the study programme in consultation with their GP. The trial will examine whether telephone-delivered, manualised treatment leads to clinically significant reduction in depression at follow-up. It will further investigate the cost-effectiveness and acceptability of the intervention in the primary care setting.DiscussionConducting a low-intensity treatment on the telephone allows for greater flexibility for both patient and therapist, can grant more anonymity and can thus lead to less hesitation in the patient about whether to attempt treatment or not. In order to benefit from this approach, large-scale studies need to prove superior effectiveness and cost-effectiveness of telephone-delivered therapy over routine care for patients with mild to moderate depression.Trial registrationClinicalTrials.gov NCT02667366. Registered on 3 December 2015.

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“…This is in line with phone-based treatments delivered within the general population. Therapies that can more easily be delivered in a manualised approach, such as cognitive behavioural therapy, have been shown to be effective for some presentations (Watzke et al , 2017).…”

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“…Not only are telephones, particularly mobile phones, a ubiquitous and well-accepted means of communication [ 62 ], but mobile devices are increasingly becoming a reliable tool for managing and delivering health care [ 63 ]. Research has shown telephone-based interventions to be effective in providing CBT for a variety of mental disorders and symptoms, including insomnia [ 63 – 66 ]. One study that compared face-to-face versus telephone-based CBT for anxiety and depression found both interventions were equally effective.…”

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“…Whereas more of those who received telephone therapy stayed with therapy, a higher proportion of them had experienced the relapse of depression after six months. Those who participated in face-to-face therapy had a slightly lower rate of staying in therapy but they were more resilient (Watzke, Haller, Steinmann et al 2017;Basu 2020). What important is, that teletherapy might significantly increase access to mental health care and the apps may draw people's attention to other opportunities of help-seeking.…”