Stepped Telemental Health Care Intervention for Depression

描述（由申请人提供）：重度抑郁症（MDD）很普遍，在成本、发病率、生活质量和死亡率方面给社会带来了非常高的负担。虽然心理治疗既有效又可被患者接受，但在开始和完成心理治疗方面存在各种障碍。远程心理健康已被提议作为克服治疗障碍的一种方法。研究主要集中在两种形式：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CBT相当，但产生更少的退出。然而，T-CBT在改善可及性方面的成功也可能显著增加医疗保健提供机构的成本。互联网CBT （iCBT）是一个典型的基于网络的程序，提供教学培训和互动工具来教授CBT技能。iCBT由简短的教练或治疗师通过电话指导，成本更低，成本效益更高，是标准的面对面治疗，但对抑郁症的改善更温和，产生的损耗率相对较高。开发一种整合T-CBT和iCBT的治疗交付模式有望利用每种媒介的优势，同时最大限度地减少缺点。阶梯式护理模式，即患者从iCBT开始，只有在病情没有改善的情况下才升级到T-CBT，是实现成功整合的潜在有用框架。我们提出了一项随机对照试验（RCT），将招募310名重度抑郁症患者，并随机分配给他们分步治疗或T-CBT。患者将继续治疗20周，或直到完全缓解，此时将停止治疗。假设1)阶梯式护理治疗不逊于T-CBT， 2)阶梯式护理治疗更具成本效益。

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.