P176 Self-management of depression in axial spondyloarthritis using internet-delivered cognitive behavioural therapy: a feasibility study
Authors: Zhao Sizheng S , Richards Derek , Goodson Nicola 
Published: April 2021

Background/Aims 

Depression is common among axial spondyloarthritis (axSpA) patients and is associated with greater axSpA disease severity. Cognitive behavioural therapy (CBT) is recommended by NICE, but access is often limited. Internet-delivered CBT (iCBT) is efficacious for treating depression in other healthcare settings. The aims of this study were to: 1) test the acceptability of iCBT for axSpA patients with depressive symptoms; and 2) evaluate whether it changes symptoms of anxiety/depression, well-being, quality of life, or axSpA disease activity.

Methods 

Adults with a rheumatologist diagnosis of axSpA with at least mild depression on screening (Patient Health Questionnaire-4 (PHQ4) score ≥3) were enrolled onto the “Space in Chronic Pain from Depression and Anxiety” programme, comprising 10 modules covering the core CBT concepts. It could be completed at the participants’ own pace over 8 weeks, with commitment of 30-45 minutes/week. Each week, a trained supporter reviewed each participant’s progress and promoted continued engagement. Participants completed BASDAI, spinal pain, BASFI, the Hospital Anxiety and Depression Scale (HADS), Warwick-Edinburgh Wellbeing Scale (WBS) and EQ5D-5L at baseline and week 8.

Results 

Between June 2019 and March 2020, 35 axSpA patients were recruited. The mean age was 50 years (SD 12) and 54% were males. The mean PHQ4 was 8.6 (SD 2.5). All participants were sent email invitations and reminders; 18 (51%) signed up. Six (17%) remained active for the full 8 weeks. The median time actively enrolled in the program was 6.3 weeks (IQR 0, 8.0), and the total time spent was a median of 2.1 hrs (IQR 2.0, 11.0); 5 did not return after the first day. There were no meaningful changes in any of the secondary outcomes between baseline and week 8. P176 Table 1:Did not sign upSigned upp-valueN1718Age, mean (SD)47.4 (11.6)52.9 (11.5)0.16Male, n (%)11 (65%)8 (44%)0.23PHQ4, mean (SD)8.4 (2.6)8.8 (2.5)0.67BASDAI baseline, mean (SD)6.1 (1.6)5.0 (2.3)0.26Spinal pain baseline, mean (SD)5.4 (2.1)5.3 (2.7)0.88BASFI baseline, mean (SD)6.1 (2.5)4.5 (2.6)0.19Delay from invitation to start, days, median (IQR)na1.0 (0.0, 14.0)naTotal weeks active in the programme, median (IQR)na6.3 (0, 8.0)naNumber of log-ins, median (IQR)na8.0 (2.0, 11.0)naTotal time spent, Hours, median (IQR)na2.1 (0.7, 3.4)naNumber of progress checks, median (IQR)na5.0 (4.0, 7.0)na

Conclusion 

iCBT may be a useful intervention for axSpA patients with depression. However, low levels of engagement and high attrition rates (common in intervention studies of depression) resulted in only 17% completing the full programme. These figures will be essential for planning of future clinical trials in this area. Future work could also consider strategies to promote engagement and use and potential adaptation of interventional content for iCBT delivery in this population.

Disclosure 

S.S. Zhao: None. D. Richards: Other; DR is the Chief Science Officer for SilverCloud Health. N. Goodson: None.