Skip to main content
Top
Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Study protocol

Effectiveness and cost-effectiveness of telephone-based cognitive-behavioural therapy in primary care: study protocol of TIDe – telephone intervention for depression

Authors: Birgit Watzke, Elisa Haller, Maya Steinmann, Daniela Heddaeus, Martin Härter, Hans-Helmut König, Karl Wegscheider, Thomas Rosemann

Published in: BMC Psychiatry | Issue 1/2017

Login to get access

Abstract

Background

Despite the availability of evidence-based treatments for depression, a large proportion of patients remains untreated or adequate treatment is initiated with delay. This situation is particularly critical in primary care, where not only most individuals first seek help for their mental health problems, but also depressive disorders – particularly mild to moderate levels of severity – are highly prevalent given the high comorbidity of chronic somatic conditions and depression. Improving the access for evidence-based treatment, especially in primary care, is hence a priority challenge in the mental health care agenda. Telephone usage is widespread and has the potential of overcoming many barriers that individuals suffering from mental health problems are facing: Its implementation for treatment delivery presents an option for optimisation of treatment pathways and outcomes.

Methods/design

This paper details the study protocol for a randomised controlled trial (RCT) evaluating the effectiveness of a telephone-administered short-term cognitive-behavioural therapy (T-CBT) for depression as compared to treatment as usual (TAU) in the Swiss primary care setting. The study aims at randomising a total of 216 mildly to moderately depressed patients, which are either identified by their General Practitioners (GPs) or who self-refer to the study programme in consultation with their GP. The trial will examine whether telephone-delivered, manualised treatment leads to clinically significant reduction in depression at follow-up. It will further investigate the cost-effectiveness and acceptability of the intervention in the primary care setting.

Discussion

Conducting a low-intensity treatment on the telephone allows for greater flexibility for both patient and therapist, can grant more anonymity and can thus lead to less hesitation in the patient about whether to attempt treatment or not. In order to benefit from this approach, large-scale studies need to prove superior effectiveness and cost-effectiveness of telephone-delivered therapy over routine care for patients with mild to moderate depression.

Trial registration

ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.
Literature
1.
go back to reference Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21(Suppl 9):655–79.CrossRefPubMed Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21(Suppl 9):655–79.CrossRefPubMed
2.
go back to reference Luppa M, Heinrich S, Angermeyer MC, et al. Cost-of-illness studies of depression. A systematic review. J Affect Disorders. 2007;98(1–2):29–43.CrossRefPubMed Luppa M, Heinrich S, Angermeyer MC, et al. Cost-of-illness studies of depression. A systematic review. J Affect Disorders. 2007;98(1–2):29–43.CrossRefPubMed
3.
go back to reference Tomonaga Y, Haettenschwiler J, Hatzinger M, Holsboer-Trachsler E, Rufer M, Hepp U, Szucs TD. The economic burden of depression in Switzerland. PharmacoEconomics. 2013;31(3):237–50.CrossRefPubMed Tomonaga Y, Haettenschwiler J, Hatzinger M, Holsboer-Trachsler E, Rufer M, Hepp U, Szucs TD. The economic burden of depression in Switzerland. PharmacoEconomics. 2013;31(3):237–50.CrossRefPubMed
4.
go back to reference World Health Organization. The world health report 2001 - mental health: new understanding, new hope. Geneva: World Health Organization; 2001. World Health Organization. The world health report 2001 - mental health: new understanding, new hope. Geneva: World Health Organization; 2001.
5.
go back to reference Shim R, Baltrus P, Ye J, Rust G. Prevalence, treatment and control of depressive symptoms in the United States: results from the National Health and nutrition examination survey (NHANES), 2005-2008. J Am Board Fam Med. 2011;24(1):33–8.CrossRefPubMedPubMedCentral Shim R, Baltrus P, Ye J, Rust G. Prevalence, treatment and control of depressive symptoms in the United States: results from the National Health and nutrition examination survey (NHANES), 2005-2008. J Am Board Fam Med. 2011;24(1):33–8.CrossRefPubMedPubMedCentral
6.
go back to reference Baer N, Schuler D, Füglister-Dousse S, Moreau-Gruet F. Depression in der Schweiz. Daten zur Epidemiologie, Behandlung und sozial-beruflichen Integration (Obsan Bericht 56). Neuchâtel: Schweizerisches Gesundheitsobservatorium; 2013. Baer N, Schuler D, Füglister-Dousse S, Moreau-Gruet F. Depression in der Schweiz. Daten zur Epidemiologie, Behandlung und sozial-beruflichen Integration (Obsan Bericht 56). Neuchâtel: Schweizerisches Gesundheitsobservatorium; 2013.
7.
go back to reference Birnbaum HG, Kessler RC, Kelley D, Ben-Hamadi R, Joish VN, Greenberg PE. Employer burden of mild, moderate, and severe major depressive disorder: mental health service utilization and costs, and work performance. Depress Anxiety. 2010;27(1):78–89.CrossRefPubMed Birnbaum HG, Kessler RC, Kelley D, Ben-Hamadi R, Joish VN, Greenberg PE. Employer burden of mild, moderate, and severe major depressive disorder: mental health service utilization and costs, and work performance. Depress Anxiety. 2010;27(1):78–89.CrossRefPubMed
8.
go back to reference DGPPN BÄK, KBV, et al. für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression. Berlin, Düsseldorf: DGPPN, ÄZQ, AWMF; 2015. DGPPN BÄK, KBV, et al. für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression. Berlin, Düsseldorf: DGPPN, ÄZQ, AWMF; 2015.
9.
go back to reference National Institute for Health and Clinical Excellence. Depression in adults - the treatment and management of depression in adults. Manchester: NICE clinical guideline 90; 2009. National Institute for Health and Clinical Excellence. Depression in adults - the treatment and management of depression in adults. Manchester: NICE clinical guideline 90; 2009.
10.
go back to reference Collins KA, Westra HA, Dozois DJ, Burns DD. Gaps in accessing treatment for anxiety and depression: challenges for the delivery of care. Clin Psychol Rev. 2004;24(5):583–616.CrossRefPubMed Collins KA, Westra HA, Dozois DJ, Burns DD. Gaps in accessing treatment for anxiety and depression: challenges for the delivery of care. Clin Psychol Rev. 2004;24(5):583–616.CrossRefPubMed
11.
go back to reference Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63(Suppl 8):24–34.PubMed Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63(Suppl 8):24–34.PubMed
12.
go back to reference Schuler D, Burla L. Psychische Gesundheit in der Schweiz. Monitoring 2012 (Obsan Bericht 52). Neuchâtel: Schweizerisches Gesundheitsobservatorium. Schuler D, Burla L. Psychische Gesundheit in der Schweiz. Monitoring 2012 (Obsan Bericht 52). Neuchâtel: Schweizerisches Gesundheitsobservatorium.
13.
go back to reference Bastawrous A, Hennig B, Livingstone I. mHealth possibilities in a changing world. Distribution of global cell phone subscriptions. J MTM. 2013;2(1):22–5.CrossRef Bastawrous A, Hennig B, Livingstone I. mHealth possibilities in a changing world. Distribution of global cell phone subscriptions. J MTM. 2013;2(1):22–5.CrossRef
14.
go back to reference Rosemann T, Joos S, Laux G, Gensichen J, Szecsenyi J. Case Management of Arthritis Patients in primary care: a cluster-randomized controlled trial. Arthritis Rheum. 2007;57:1390–7.CrossRefPubMed Rosemann T, Joos S, Laux G, Gensichen J, Szecsenyi J. Case Management of Arthritis Patients in primary care: a cluster-randomized controlled trial. Arthritis Rheum. 2007;57:1390–7.CrossRefPubMed
15.
go back to reference Mons U, Raum E, Kramer HU, Rüter G, Rothenbacher D, Rosemann T, Szecsenyi J, Brenner H. Effectiveness of a supportive telephone counseling intervention in type 2 diabetes patients: randomized controlled study. PLoS One. 2013;8(10):e77954.CrossRefPubMedPubMedCentral Mons U, Raum E, Kramer HU, Rüter G, Rothenbacher D, Rosemann T, Szecsenyi J, Brenner H. Effectiveness of a supportive telephone counseling intervention in type 2 diabetes patients: randomized controlled study. PLoS One. 2013;8(10):e77954.CrossRefPubMedPubMedCentral
16.
go back to reference Brenes GA, Miller ME, Williamson JD, McCall WV, Knudson M, Stanley MA. A randomized controlled trial of telephone-delivered cognitive-behavioral therapy for late-life anxiety disorders. Am J Geriatr Psychiatry. 2012;20(8):707–16.CrossRefPubMedPubMedCentral Brenes GA, Miller ME, Williamson JD, McCall WV, Knudson M, Stanley MA. A randomized controlled trial of telephone-delivered cognitive-behavioral therapy for late-life anxiety disorders. Am J Geriatr Psychiatry. 2012;20(8):707–16.CrossRefPubMedPubMedCentral
17.
go back to reference Brenes GA, Danhauser SC, Lyles MF, Anderson A, Miller ME. Effects of telephone-delivered cognitive-behavioral therapy and nondirective supportive therapy on sleep, health-related quality of life, and disability. Am J Geriatr Psychiatry. 2016;24(10):846–54.CrossRefPubMed Brenes GA, Danhauser SC, Lyles MF, Anderson A, Miller ME. Effects of telephone-delivered cognitive-behavioral therapy and nondirective supportive therapy on sleep, health-related quality of life, and disability. Am J Geriatr Psychiatry. 2016;24(10):846–54.CrossRefPubMed
18.
go back to reference Mohr DC, Vella L, Hart S, Heckman T, Simon G. The effect of telephone-administered psychotherapy on symptoms of depression and attrition: a meta-analysis. Clin Psychol. 2008;15:243–53. Mohr DC, Vella L, Hart S, Heckman T, Simon G. The effect of telephone-administered psychotherapy on symptoms of depression and attrition: a meta-analysis. Clin Psychol. 2008;15:243–53.
19.
go back to reference Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, et al. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients. A Randomized Trial. JAMA. 2012;207(21):2278–85. Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, et al. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients. A Randomized Trial. JAMA. 2012;207(21):2278–85.
20.
go back to reference Mohr DC, Hart SL, Julian L, et al. Telephone-administered psychotherapy for depression. Arch Gen Psychiatry. 2006;62(9):1007–14.CrossRef Mohr DC, Hart SL, Julian L, et al. Telephone-administered psychotherapy for depression. Arch Gen Psychiatry. 2006;62(9):1007–14.CrossRef
21.
go back to reference Heckman TG, Barcikowski R, Ogles B, Suhr J, Carlson B, Holroyd K, et al. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med. 2006;32(1):27–38.CrossRefPubMed Heckman TG, Barcikowski R, Ogles B, Suhr J, Carlson B, Holroyd K, et al. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med. 2006;32(1):27–38.CrossRefPubMed
22.
go back to reference Mohr DC, Likosky W, Bertagnolli A, Goodkin DE, Van Der Wende J, Dwyer P, Dick LP. Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J Consult Clin Psychol. 2000;68:356–61.CrossRefPubMed Mohr DC, Likosky W, Bertagnolli A, Goodkin DE, Van Der Wende J, Dwyer P, Dick LP. Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J Consult Clin Psychol. 2000;68:356–61.CrossRefPubMed
23.
go back to reference Sandgren AK, McCaul KD. Short-term effects of telephone therapy for breast cancer patients. Health Psychol. 2003;22:310–5.CrossRefPubMed Sandgren AK, McCaul KD. Short-term effects of telephone therapy for breast cancer patients. Health Psychol. 2003;22:310–5.CrossRefPubMed
24.
go back to reference Simon GE, Ludman EG, Tutty S, Operskalski B, Von Korff M. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. JAMA. 2004;292(8):935–42.CrossRefPubMed Simon GE, Ludman EG, Tutty S, Operskalski B, Von Korff M. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. JAMA. 2004;292(8):935–42.CrossRefPubMed
25.
go back to reference Tutty S, Simon G, Ludman E. Telephone counseling as an adjunct to antidepressant treatment in the primary care system. A pilot study. Eff Clin Pract. 2000;3:170–8.PubMed Tutty S, Simon G, Ludman E. Telephone counseling as an adjunct to antidepressant treatment in the primary care system. A pilot study. Eff Clin Pract. 2000;3:170–8.PubMed
26.
go back to reference Tutty S, Spangler DL, Poppleton L, Ludman EJ, Simon GE. Evaluating the effectiveness of cognitive-behavioral Teletherapy in depressed adults. Behav Ther. 2010;41:229–36.CrossRefPubMed Tutty S, Spangler DL, Poppleton L, Ludman EJ, Simon GE. Evaluating the effectiveness of cognitive-behavioral Teletherapy in depressed adults. Behav Ther. 2010;41:229–36.CrossRefPubMed
27.
go back to reference Steinmann M, Heddaeus D, Liebherz S, Weymann N, Härter M, Watzke B. Telefongestützte Verhaltenstherapie als niedrigschwellige Intervention bei Depression: Ein Behandlungsprogramm für den deutschen Sprachraum. Verhaltenstherapie. 2016;26:244–53.CrossRef Steinmann M, Heddaeus D, Liebherz S, Weymann N, Härter M, Watzke B. Telefongestützte Verhaltenstherapie als niedrigschwellige Intervention bei Depression: Ein Behandlungsprogramm für den deutschen Sprachraum. Verhaltenstherapie. 2016;26:244–53.CrossRef
28.
go back to reference Watzke B, Heddaeus D, Steinmann S, König H-H, Wegscheider K, Schulz H, Härter M. Effectiveness and cost-effectiveness of a guideline-based stepped care model for patients with depression: study protocol of a cluster-randomized controlled trial in routine care. BMC Psychiatry. 2014;14:230.CrossRefPubMedPubMedCentral Watzke B, Heddaeus D, Steinmann S, König H-H, Wegscheider K, Schulz H, Härter M. Effectiveness and cost-effectiveness of a guideline-based stepped care model for patients with depression: study protocol of a cluster-randomized controlled trial in routine care. BMC Psychiatry. 2014;14:230.CrossRefPubMedPubMedCentral
29.
go back to reference Löwe B, Spitzer RL, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ-D): Manual und Testunterlagen. Karlsruhe: Pfizer; 2002. Löwe B, Spitzer RL, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ-D): Manual und Testunterlagen. Karlsruhe: Pfizer; 2002.
30.
go back to reference Gräfe K, Zipfel S, Herzog W, Löwe B. Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)” Ergebnisse der deutschen Validierungsstudie. Diagnostica. 2004;50(Suppl 4):171–81.CrossRef Gräfe K, Zipfel S, Herzog W, Löwe B. Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)” Ergebnisse der deutschen Validierungsstudie. Diagnostica. 2004;50(Suppl 4):171–81.CrossRef
32.
go back to reference Bullinger M, Kirchberger I. SF-36. Fragebogen zum Gesundheitszustand. Göttingen: Hogrefe; 1998. Bullinger M, Kirchberger I. SF-36. Fragebogen zum Gesundheitszustand. Göttingen: Hogrefe; 1998.
33.
go back to reference Ferring D, Filipp H-S. Messung des Selbstwertgefühls: Befunde zu Reliabilität, Validität und Stabilität der Rosenberg-Skala. Diagnostica. 1996;42:284–92. Ferring D, Filipp H-S. Messung des Selbstwertgefühls: Befunde zu Reliabilität, Validität und Stabilität der Rosenberg-Skala. Diagnostica. 1996;42:284–92.
34.
go back to reference Jerusalem M, Schwarzer R. Skalen zur Erfassung von Lehrer- und Schülermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der Wissenschaftlichen Begleitung der Modellversuchs Selbstwirksame Schulen. Berlin: Freie Universität Berlin; 1999. Jerusalem M, Schwarzer R. Skalen zur Erfassung von Lehrer- und Schülermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der Wissenschaftlichen Begleitung der Modellversuchs Selbstwirksame Schulen. Berlin: Freie Universität Berlin; 1999.
35.
go back to reference Ludman E, Katon W, Bush T, Rutter C, Lin E, Simon G, et al. Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial. Psychol Med. 2003;33(Suppl 6):1061–70.CrossRefPubMed Ludman E, Katon W, Bush T, Rutter C, Lin E, Simon G, et al. Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial. Psychol Med. 2003;33(Suppl 6):1061–70.CrossRefPubMed
36.
go back to reference Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B. Client SocioDemographic and Service Receipt Inventory--European Version: development of an instrument for international research. EPSILON Study 5. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl. 2000;39:28–33. Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B. Client SocioDemographic and Service Receipt Inventory--European Version: development of an instrument for international research. EPSILON Study 5. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl. 2000;39:28–33.
37.
go back to reference The EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(Suppl 3):199–208. The EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(Suppl 3):199–208.
38.
go back to reference Schulz H, Lang K, Nübling R, Koch U. Psychometrische Überprüfung einer Kurzform des Fragebogens zur Psychotherapiemotivation - FPTM-23. Diagnostica. 2003;49:83–93.CrossRef Schulz H, Lang K, Nübling R, Koch U. Psychometrische Überprüfung einer Kurzform des Fragebogens zur Psychotherapiemotivation - FPTM-23. Diagnostica. 2003;49:83–93.CrossRef
39.
go back to reference Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001;357(9263):1191–4.CrossRefPubMed Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001;357(9263):1191–4.CrossRefPubMed
Metadata
Title
Effectiveness and cost-effectiveness of telephone-based cognitive-behavioural therapy in primary care: study protocol of TIDe – telephone intervention for depression
Authors
Birgit Watzke
Elisa Haller
Maya Steinmann
Daniela Heddaeus
Martin Härter
Hans-Helmut König
Karl Wegscheider
Thomas Rosemann
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1429-5

Other articles of this Issue 1/2017

BMC Psychiatry 1/2017 Go to the issue