Adapting depression collaborative care models to increase uptake of computerized cognitive behavioral therapy at the VA: A pilot randomized controlled trial

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-07-29 DOI:10.1016/j.genhosppsych.2025.07.014

Lucinda B. Leung , Catherine E. Brayton , Sona Hovsepian , Michael A. Karakashian , Karen Chu , Nicholas J. Jackson , Paul G. Shekelle , Alison B. Hamilton , Elizabeth M. Yano , Bruce L. Rollman , Alexander S. Young

{"title":"Adapting depression collaborative care models to increase uptake of computerized cognitive behavioral therapy at the VA: A pilot randomized controlled trial","authors":"Lucinda B. Leung , Catherine E. Brayton , Sona Hovsepian , Michael A. Karakashian , Karen Chu , Nicholas J. Jackson , Paul G. Shekelle , Alison B. Hamilton , Elizabeth M. Yano , Bruce L. Rollman , Alexander S. Young","doi":"10.1016/j.genhosppsych.2025.07.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To examine the feasibility, acceptability, and potential health effects of computerized cognitive behavioral therapy-enhanced collaborative care (cCBT-CC) versus usual primary care (UC).</div></div><div><h3>Background</h3><div>Internet-based cCBT can effectively treat depression but is not widely used, including in the Veterans Health Administration where it was freely available for veterans. We adapted pre-existing depression collaborative care models using implementation and user-centered design strategies to facilitate cCBT implementation.</div></div><div><h3>Methods</h3><div>This pilot randomized controlled trial (RCT) included 57 VA primary care patients to cCBT-CC or UC. Participants had Patient Health Questionnaire (PHQ-9) scores of 10+. Those with serious mental illness (e.g., bipolar depression, schizophrenia) and active suicidality were excluded. Intervention patients received tailored Vets Prevail cCBT accompanied by collaborative care manager support, overseen by psychiatry and primary care. UC offered collaborative care services and digital mental health tools at baseline. Feasibility (patient reach, provider adoption, intervention implementation), acceptability (CSQ-8), and potential effectiveness (PHQ-9) data was collected at baseline and 3-months by a blinded study team member.</div></div><div><h3>Results</h3><div>Participants (cCBT-CC <em>n</em> = 29, UC <em>n</em> = 28) were 50 years old (mean); 70 % men; 32 % White, 32 % Hispanic, 25 % Black; 21 % homeless-experienced. Mean baseline PHQ-9 scores were 15.1 (SD = 5.0); 39 % reported suicidal thoughts/behaviors. 72 % of 94 primary care providers, from 6 out of the 8 participating clinics, helped support their patients' participation. cCBT-CC participants received 4 care manager check-ins over 33 days totaling 113 min (64 % clinical; 36 % technical), on average. They completed mean 6.7 out of 11 cCBT lessons. Participants in the cCBT-CC arm experienced a statistically (not clinically) significant decline in the primary outcome of depression (Δ = -2.5; <em>p</em> = 0.02) symptoms from pretreatment to posttreatment. There was a greater, albeit non-significant, decrease in PHQ-9 scores among cCBT-CC participants over 3-months, compared to UC participants (Δ = -2.8; 95 % CI = -5.6, −0.01; <em>p</em> = 0.05).</div></div><div><h3>Conclusions</h3><div>cCBT-enhanced collaborative care appeared feasible, acceptable, and possibly effective in treating primary care patients with depression.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"96 ","pages":"Pages 223-233"},"PeriodicalIF":3.7000,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"General hospital psychiatry","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0163834325001501","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To examine the feasibility, acceptability, and potential health effects of computerized cognitive behavioral therapy-enhanced collaborative care (cCBT-CC) versus usual primary care (UC).

Background

Internet-based cCBT can effectively treat depression but is not widely used, including in the Veterans Health Administration where it was freely available for veterans. We adapted pre-existing depression collaborative care models using implementation and user-centered design strategies to facilitate cCBT implementation.

Methods

This pilot randomized controlled trial (RCT) included 57 VA primary care patients to cCBT-CC or UC. Participants had Patient Health Questionnaire (PHQ-9) scores of 10+. Those with serious mental illness (e.g., bipolar depression, schizophrenia) and active suicidality were excluded. Intervention patients received tailored Vets Prevail cCBT accompanied by collaborative care manager support, overseen by psychiatry and primary care. UC offered collaborative care services and digital mental health tools at baseline. Feasibility (patient reach, provider adoption, intervention implementation), acceptability (CSQ-8), and potential effectiveness (PHQ-9) data was collected at baseline and 3-months by a blinded study team member.

Results

Participants (cCBT-CC n = 29, UC n = 28) were 50 years old (mean); 70 % men; 32 % White, 32 % Hispanic, 25 % Black; 21 % homeless-experienced. Mean baseline PHQ-9 scores were 15.1 (SD = 5.0); 39 % reported suicidal thoughts/behaviors. 72 % of 94 primary care providers, from 6 out of the 8 participating clinics, helped support their patients' participation. cCBT-CC participants received 4 care manager check-ins over 33 days totaling 113 min (64 % clinical; 36 % technical), on average. They completed mean 6.7 out of 11 cCBT lessons. Participants in the cCBT-CC arm experienced a statistically (not clinically) significant decline in the primary outcome of depression (Δ = -2.5; p = 0.02) symptoms from pretreatment to posttreatment. There was a greater, albeit non-significant, decrease in PHQ-9 scores among cCBT-CC participants over 3-months, compared to UC participants (Δ = -2.8; 95 % CI = -5.6, −0.01; p = 0.05).

Conclusions

cCBT-enhanced collaborative care appeared feasible, acceptable, and possibly effective in treating primary care patients with depression.

查看原文本刊更多论文

调整抑郁症协作护理模式以增加计算机化认知行为治疗在VA的应用：一项试点随机对照试验

目的探讨计算机认知行为治疗-增强协作护理（cCBT-CC）与常规初级保健（UC）的可行性、可接受性和潜在健康影响。基于互联网的cCBT可以有效治疗抑郁症，但并没有被广泛使用，包括在退伍军人健康管理局，它是免费提供给退伍军人的。我们采用实施和以用户为中心的设计策略调整了已有的抑郁症协作护理模式，以促进cCBT的实施。方法本试验随机对照试验（RCT）纳入57例VA初级保健患者cCBT-CC或UC。参与者的患者健康问卷（PHQ-9）得分为10+。那些患有严重精神疾病（如双相抑郁症、精神分裂症）和主动自杀倾向的人被排除在外。干预患者接受量身定制的Vets盛行cCBT，并由精神病学和初级保健部门提供协作护理经理支持。UC在基线上提供协作护理服务和数字心理健康工具。可行性（患者覆盖范围、提供者采用、干预实施）、可接受性（CSQ-8）和潜在有效性（PHQ-9）数据由一名盲法研究团队成员在基线和3个月时收集。结果cCBT-CC患者29例，UC患者28例，平均年龄50岁；男性占70%；白人32%，西班牙裔32%，黑人25%；21%的人无家可归。PHQ-9平均基线评分为15.1分（SD = 5.0）；39%的人有自杀念头/行为。来自8个参与诊所中的6个诊所的94个初级保健提供者中，72%的人帮助支持患者参与。cCBT-CC参与者在33天内接受了4次护理经理检查，总计113分钟(64%临床；36%的技术)，平均。他们平均完成了11节cCBT课程中的6.7节。cCBT-CC组的参与者在抑郁症的主要结局方面有统计学（非临床）显著下降(Δ = -2.5；P = 0.02)。与UC参与者相比，cCBT-CC参与者在3个月内的PHQ-9评分下降幅度更大，尽管不显著(Δ = -2.8；95% ci = -5.6,−0.01；p = 0.05)。结论cbt增强的协同护理在治疗初级保健抑郁症患者中可行、可接受且可能有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.