european comparative effectiveness research on internet-based depression treatment

Conditions: Depressive Disorder

Summary: to compare the clinical impact and cost-effectiveness of blended cognitive behavioural therapy (cbt) for adults with major depressive disorder (mdd) with treatment as usual (tau). within the french context the tau is considered as the traditional face to face cbt.

background: depression is a common mental disorder with a negative impact on mental well-being, quality of life, and social and work-related functioning both in the short and longer term. additionally, depression is associated with increased morbidity, mortality, health care utilization and health care costs. on a population level, depression is one of the most costly diseases. the economic costs of depression were estimated at €136.3 billion (eu25) in 2010 in the eu and are still rising. european health care systems face the challenge of improving access to cost-effective treatments while simultaneously working to sustain budgetary stability in times of economic austerity. internet-based depression treatment appears a very promising alternative to current routine depression treatment strategies. meta-analyses have demonstrated the clinical effectiveness and potential cost-effectiveness of internet-based treatment for depression in controlled research setting. internet-based treatment thus has the potential to keep depression treatment affordable, as it enables mental health care providers to reach out to large populations needing depression treatment at a better cost-effectiveness than those of standard treatment as usual (tau), but with similar levels of clinical efficacy and quality of care. the trials will be conducted in 8 european countries. objective: to compare the clinical impact and cost-effectiveness of blended cognitive behavioural therapy (cbt) for adults with major depressive disorder (mdd) with treatments as usual (tau)-face to face cbt in expert centres specialized in depression. study design: the study is a two-arm randomized controlled non-inferiority and cost-effectiveness trial. the trial will be conducted in expert centres in france. a total of 150 patients with mdd will be assigned to one of two treatment arms: 1) blended cbt, 2) tau. respondents in both arms will be followed until 12 months after baseline (measures will be taken at baseline, 3 months, post- treatment (17 weeks), 6 months and 12 months).

Eligibility criteria:
inclusion criteria: * being 18 years of age or older * meet dsm-iv diagnostic criteria for mdd confirmed by mini international neuropsychiatric interview version 5.0 * having a phq-9 score greater than 5 * having access to a pc and internet connection * having ( or accepting to be loaned) a smartphone that is compatible with the mobile component of the intervention * understanding of the french language spoken and written exclusion criteria: * current high risk for suicide according to the mini interview section c * serious psychiatric co-morbidity: substance dependence, bipolar affective disorder, psychotic illness, obsessive compulsive disorder, and suicide risks, as established at the mini interview * currently receiving psychological treatment for depression

Keywords: e-health depressive disorder cost-effectiveness cognitive behavioral treatment