The pandemic has brought mental health needs to the forefront. Whether it’s front-line workers who have been dealing with the serious health needs of COVID patients, essential workers who have been working through the pandemic, or those who lost their livelihood or loved ones because of the pandemic, mental health has been impacted.
Data is clear that stress, insomnia, anxiety, and depression are on the rise in most countries, in addition to deaths of despair. Mental health systems were already strained pre-pandemic, so how might digital health tools help people manage through this moment to support their mental health?
A new paper by Eirini Karyotaki and colleagues from Harvard Medical School published in JAMA Psychiatry adds more findings to the value of internet-based Cognitive Behavioral Therapy (iCBT) in alleviating depression. The study is a systematic review consisting of 9,751 participants derived from 39 studies whose participants experienced internet-based CBT, either guided (therapeutic) or unguided, as an intervention for subthreshold to mild-moderate depression. The Patient Health Questionnaire 9 (PHQ-9) was used to assess depression, and 15-20% of the general population experience these levels of depression at any given time.
Findings indicate iCBT, whether via guided or unguided means, was more effective in alleviating depression when compared to control participants. This finding held for two different timeframes, short-term (six months) and long-term (12 months). While both modes were useful, guided iCBT showed more effectiveness. The authors point out that the participant’s baseline depression score was the most important modifier for the effectiveness of guided vs. unguided iCBT. Those experiencing symptoms in the moderate range did better with guided iCBT; there was no difference in the modality for those experiencing sub-threshold depression.
What does this all mean? The good news is unguided iCBT has many solutions on the market with the potential to scale to meet the growing need to support people through the pandemic and beyond. This study demonstrates that for people experiencing sub-threshold or mild symptoms, their needs can be met by unguided iCBT. This frees up the precious resource of therapist time to provide guided iCBT to individuals experiencing moderate depression. Many countries have a stepped care model for mental health, and scalable solutions can be added to these stepped care models to serve more people, reducing the burden of suffering.
Thanks for reading – Trina
(Opinions are my own)
Karyotaki E, Efthimiou O, Miguel C, et al. Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis. JAMA Psychiatry. Published online January 20, 2021. doi:10.1001/jamapsychiatry.2020.4364