Stepped Telemental Health Care Intervention for Depression

描述(由申请人提供)：严重抑郁障碍(MDD)很普遍，在成本、发病率、生活质量和死亡率方面都造成了非常高的社会负担。虽然心理治疗既有效又为患者所接受，但启动和完成心理治疗存在各种障碍。远程健康被认为是克服治疗障碍的一种方法。研究主要集中在两种方式上：电话和互联网。电话管理的认知行为疗法(T-CBT)在疗效上似乎与面对面的认知行为疗法相同，但产生的辍学更少。然而，T-CBT在改善接入方面的成功也可能显著增加医疗保健提供组织的成本。互联网CBT(ICBT)通常是一个基于网络的项目，提供教学培训和互动工具来教授CBT技能。由简短的教练或治疗师通过电话指导的iCBT大大降低了成本，更具成本效益和标准的面对面治疗，但对抑郁症有更温和的改善，并产生相对较高的自然减少率。开发一种整合T-CBT和iCBT的治疗提供模式有望利用每种媒介的优势，同时将劣势降至最低。分级护理模式，即患者从iCBT开始，只有在他们没有改善的情况下才逐步进入T-CBT，这是实现成功整合的潜在有用框架。我们已经提出了一项随机对照试验(RCT)，该试验将招募310名MDD患者，并随机将他们分配到分级护理或T-CBT。患者将继续接受治疗20周，或直到完全缓解，届时将停止治疗。假设1)阶梯式治疗不会低于T-CBT，2)阶梯式治疗将更具成本效益。

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is prevalent and imposes a very high societal burden in terms of cost, morbidity, quality of life, and mortality. While psychological treatments are both effective and acceptable to patients, a variety of barriers exist both to initiating and completing psychotherapy. Telemental health has been proposed as a method of overcoming barriers to treatment. Research has focused primarily on two formats: the telephone and the Internet. Telephone-administered cognitive behavioral therapy (T-CBT) appears to be equivalent to face-to-face CBT in efficacy, but produces fewer dropouts. However, T-CBT's success in improving access could also significantly increase costs for healthcare providing organizations. Internet CBT (iCBT) is typically a web-based program that provides didactic training and interactive tools to teach CBT skills. iCBT guided by brief coach or therapist via telephone is substantially less costly and more cost effective and standard face-to-face treatment, but produces more moderate improvements in depression and produces comparatively high levels of attrition. Developing a treatment delivery model that integrates T-CBT and iCBT holds the promise of harnessing the advantages of each medium, while minimizing the disadvantages. A stepped care model, in which patients begin with iCBT and are stepped up to T-CBT only if they do not improve, is a potentially useful framework for achieving a successful integration. We have proposed a randomized controlled trial (RCT) that will recruit 310 patients with MDD, and randomly assign them to stepped care or T-CBT. Patients will remain in treatment for 20 weeks, or until full remission is reached, at which point treatment would be discontinued. It is hypothesized that 1) the stepped care treatment will not be inferior to T-CBT and 2) stepped care will be more cost-efficient.