Web-based Therapy Plus Support by a Coach in Depressed Patients Referred to Secondary Mental Health Care: Randomized...

Area of Science:

• Mental Health
• Digital Health
• Clinical Psychology

Background:

• Evidence for Web-based therapies is limited in secondary mental health care populations with depression.
• Adherence to Web-based therapies is a significant challenge.
• A coach-supported model may improve engagement and adherence.

Purpose of the Study:

• To evaluate the effectiveness of a coach-supported Web-based therapy (The Journal) compared to usual care for depression in secondary care.
• To assess depression symptom reduction at 12 weeks.
• To explore adherence and patient experience through a process evaluation.

Main Methods:

• A randomized controlled trial with two parallel arms.
• Intervention: Web-based therapy (The Journal) with a coach plus usual care.
• Control: Usual care plus an information leaflet.
• Process evaluation included qualitative interviews and completion data.

Main Results:

• No statistically significant difference in depression scores (PHQ-9) between the intervention and control groups at 12 weeks.
• The intervention group attended fewer outpatient appointments, though not statistically significant.
• Low completion rates for Web-based therapy lessons and limited engagement with the coach were observed.
• Qualitative findings highlighted clinician engagement issues, technical difficulties, and accessibility problems.

Conclusions:

• A coach-supported Web-based therapy is feasible in secondary mental health care and perceived as helpful.
• Significant improvements in depression scores were not achieved, likely due to adherence and technical barriers.
• Future trials require early clinician engagement, mobile accessibility, and simplified login processes for Web-based therapies.