Digital mental health solutions have been growing in the past few years, over 10,000 mental health apps can be found on the app store. The current pandemic has offered digital health an opportunity to meet needs in new ways. Many digital mental health companies are accelerating deployment, or have made their app free to support people at this time.
From the existing evidence base, we know Cognitive Behavioral Therapy (CBT) effectively provides relief from depression and anxiety. In fact, CBT in all modalities works. A growing body of evidence is also demonstrating that in real-world implementation, these solutions also show efficacy.
A new paper by Derek Richards and colleagues from the University of Dublin, Trinity College, Ireland in Nature Digital Medicine reports the findings from a pragmatic trial of Silvercloud. The National Health Service (NHS) has a stepped care model known as Improving Access to Psychological Therapies (IAPT). This model aims to provide the right care to the right patient at the right time, with an ability to step up or step down care as warranted. In the model, step two is where low-intensity interventions are offered to patients who are experiencing mild to moderate depression or anxiety. Internet-based CBT (iCBT) is often provided in this step to augment care. In this study, 361 participants were randomized into an iCBT group (241) or a wait-list control group (120). Depression and anxiety symptoms were assessed throughout the study, and cost-effectiveness was also measured.
Findings indicate that those who had iCBT showed significant improvement in their depression and anxiety over the 8-week study period. Functional impairment was also lowered in the intervention group. Follow-up also demonstrated these changes were enduring at 3, 6, 9, and 12 months. Cost-effectiveness was measured using the standard QALYS- or quality of life years; in the UK, 30,000 pounds is the cutpoint NICE uses to determine if an intervention is cost-effective. Findings indicate the QALYS were just under that threshold. One challenge with measuring cost-effectiveness is there may be an increase in direct costs (more visits, more medications, etc.) as someone is getting appropriate levels of care. It often does not account for societal costs, which are substantial for those suffering from depression and anxiety.
This study demonstrates the value in real-world settings of adding iCBT to a stepped care model. Given the access challenges, many countries face regarding mental health services, and the increased demand due to the pandemic having evidence-based digital mental health tools to augment care is one method to scale and meet the demand that is rapidly becoming a standard of care.
Thanks for reading – Trina
(Opinions are my own)
Richards, D., Enrique, A., Eilert, N. et al. A pragmatic randomized waitlist-controlled effectiveness and cost-effectiveness trial of digital interventions for depression and anxiety. npj Digit. Med. 3, 85 (2020). https://doi.org/10.1038/s41746-020-0293-8