Patients with depression are less likely to drop out of therapy for psychiatric conditions that is administered over the phone than therapy delivered face-to-face, according to a study published in JAMA today.
Many patients with depression report a preference for psychotherapy over medication. But following through on such therapy can be difficult for patients with depression, who must overcome some of the symptoms of the disorder, such as feelings of hopelessness, lack of energy, and avoidance of activities, as well as other barriers to regularly attend therapy sessions. In fact, attrition may be as high as 30% to 50% according to some studies.
Recognizing these challenges, a team of scientists from Chicago conducted a randomized clinical trial comparing attrition and treatment effectiveness among 325 patients assigned to receive cognitive behavioral therapy (CBT) by phone or face-to-face. The researchers found that fewer patients in the telephone-based therapy group quit early (20.9% vs 32.7%) and that there were no differences in treatment outcomes between the groups soon after treatment. However, participants in face-to-face therapy were more likely to be in full remission at 6 months after therapy (32% vs 19%) and had a lower rate of depression (26% vs 29%).
Jenna Duffecy, PhD, a research assistant professor at Northwestern University in Evanston, Ill, discussed the findings with news@JAMA.
news@JAMA: Why were patients in the telemedicine group less likely to drop out?
Dr Duffecy: We know that 75% of patients can’t access psychotherapy because of barriers such as lack of time, no access to transportation, or inability to afford child care. The telephone reduces a lot of those barriers. The telephone also makes it easier to [overcome depression symptoms to access care].
In the telephone group, 4 out of 5 patients completed 18 sessions compared to 2 out of 3 in the face-to-face group. This is an effective way to provide care to people who otherwise wouldn’t receive it.
news@JAMA: What did the timing of the dropouts tell you?
Dr Duffecy: Most of the dropouts occurred in the first 4 weeks. Often people drop out of therapy because they feel it’s not working right. But when you use the telephone to overcome barriers, you can get them to the point where they see that therapy can be effective.
news@JAMA: Why do you think that face-to-face care had greater effects on depression symptoms over time?
Dr Duffecy: One of the big things I’d like to make clear is that both groups had sustained improvements in depression severity. But at the end of 6 months, the telemedicine group was 3 points higher on the Hamilton Rating Scale for Depression than the face-to-face group. That is statistically significant but the clinical significance is not clear.
We are looking at a lot of things that could have contributed to this difference. Because we retained people at greater rates in telephone-based therapy than face-to-face, there might have been greater pathology or comorbidities among the individuals who would have dropped out of face-to-face therapy but who stayed in telephone therapy. There might be something about face-to-face therapy that may allow you to get better results. The act of just getting out of the house might help patients take the steps they need to overcome depression.
news@JAMA: What do you think the findings tell us about the overall potential for telemedicine in the treatment of depression and other psychiatric conditions?
Dr Duffecy: I think there is great potential. It is easier for people to attend and complete. It can help people get the care they need. We only looked at depression, but cognitive behavioral therapy is used in a lot of disorders. We’ve demonstrated that [telemedicine CBT] is safe. We didn’t have any problems with self harm. The therapists were able to form bonds and the patients were engaged.
news@JAMA: Are there particular patient populations who may benefit from psychiatric telemedicine?
Dr Duffecy: We think this intervention could have a lot of relevance in rural communities or for people with chronic conditions [that limit mobility]. In a lot of rural communities, there aren’t enough providers. If care could be provided over the phone, it would give patients access to treatment that wouldn’t be available nearby.