A Randomized Controlled Trial Evaluating a Manualized TeleCoaching Protocol for Improving Adherence to a Web-Based Intervention for the Treatment of Depression

被引：114

作者：

Mohr, David C. ^{[1
]}

Duffecy, Jenna ^{[1
]}

Ho, Joyce ^{[1
]}

Kwasny, Mary ^{[1
]}

Cai, Xuan ^{[1
]}

Burns, Michelle Nicole ^{[1
]}

Begale, Mark ^{[1
]}

机构：

[1] Northwestern Univ, Feinberg Sch Med, Dept Prevent Med, Ctr Behav Intervent Technol, Chicago, IL 60611 USA

来源：

PLOS ONE | 2013年 / 8卷 / 08期

基金：

美国国家卫生研究院;

关键词：

COGNITIVE-BEHAVIORAL THERAPY; INTERNET-BASED TREATMENT; PSYCHOLOGICAL TREATMENTS; PRIMARY-CARE; ANXIETY; BARRIERS; INTERVIEW; SYMPTOMS; VALIDITY; SUPPORT;

D O I：

10.1371/journal.pone.0070086

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background: Web-based interventions for depression that are supported by coaching have generally produced larger effect-sizes, relative to standalone web-based interventions. This is likely due to the effect of coaching on adherence. We evaluated the efficacy of a manualized telephone coaching intervention (TeleCoach) aimed at improving adherence to a web-based intervention (moodManager), as well as the relationship between adherence and depressive symptom outcomes. Methods: 101 patients with MDD, recruited from primary care, were randomized to 12 weeks moodManager+TeleCoach, 12 weeks of self-directed moodManager, or 6 weeks of a waitlist control (WLC). Depressive symptom severity was measured using the PHQ-9. Results: TeleCoach+moodManager, compared to self-directed moodManager, resulted in significantly greater numbers of login days (p = 0.01), greater time until last use (p = 0.007), greater use of lessons (p = 0.03), greater variety of interactive tools used (p = 0.02), but total instances of tool use did not reach statistical significance. (p = 0.07). TeleCoach+moodManager produced significantly lower PHQ-9 scores relative to WLC at week 6 (p = 0.04), but there were no other significant differences in PHQ-9 scores at weeks 6 or 12 (ps>0.20) across treatment arms. Baseline PHQ-9 scores were no significantly related to adherence to moodManager. Conclusions: TeleCoach produced significantly greater adherence to moodManager, relative to self-directed moodManager. TeleCoached moodManager produced greater reductions in depressive symptoms relative to WLC, however, there were no statistically significant differences relative to self-directed moodManager. While greater use was associated with better outcomes, most users in both TeleCoach and self-directed moodManager had dropped out of treatment by week 12. Even with telephone coaching, adherence to web-based interventions for depression remains a challenge. Methods of improving coaching models are discussed.

引用

页数：9