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

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>TeleCoach+moodManager, compared to self-directed moodManager, resulted in significantly greater numbers of login days (<i>p</i> = 0.01), greater time until last use (<i>p</i> = 0.007), greater use of lessons (<i>p</i> = 0.03), greater variety of interactive tools used (<i>p</i> = 0.02), but total instances of tool use did not reach statistical significance. (<i>p</i> = 0.07). TeleCoach+moodManager produced significantly lower PHQ-9 scores relative to WLC at week 6 (<i>p</i> = 0.04), but there were no other significant differences in PHQ-9 scores at weeks 6 or 12 (<i>p</i>s>0.20) across treatment arms. Baseline PHQ-9 scores were no significantly related to adherence to moodManager.</p><p>Conclusions</p><p>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.</p><p>Trial Registration</p><p>Clinicaltrials.gov <a href="http://clinicaltrials.gov/ct2/show/NCT00719979?term=NCT00719979&rank=1" target="_blank">NCT00719979</a></p></div

Flow of study participants through the trial.

<p>Flow of study participants through the trial.</p

Least square means and standard errors for PHQ-9 depression symptom severity scores.

<p>Least square means and standard errors for PHQ-9 depression symptom severity scores.</p