Longer-term effects of modernized collaborative care for depression on multiple mental health factors (eIMPACT): A randomized controlled trial.

BACKGROUND

Integrating digital mental health into collaborative care could address multiple mental health factors. To determine the longer-term effects of modernized collaborative care for depression on overlapping mental health factors, we analyzed data from the eIMPACT trial.

METHODS

Primary care patients with depression and elevated cardiovascular disease risk (N = 216, Mage: 59 years, 78 % female, 50 % Black, 46 % with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [iCBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression. Depressive symptoms (Hopkins Symptom Checklist-20 [SCL-20] and Patient Health Questionnaire-9 [PHQ-9]), anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]), hostility/anger/aggression (Buss-Perry Aggression Questionnaire [BPAQ]), and trait positive affect (Positive and Negative Affect Schedule-Positive Affect Subscale [PANAS-PA]) were measured at 0, 6, 12, and 24 months.

RESULTS

Compared to the usual care group, the intervention group exhibited significant improvements across all outcomes. The intervention group advantage increased over the treatment period, peaked at post-treatment (12 months: SCL-20 dadj = -0.57, PHQ-9 dadj = -0.63, GAD-7 dadj = -0.50, BPAQ dadj = -0.17, PANAS-PA dadj = 0.41), and decreased over the follow-up period (24 months: SCL-20 dadj = -0.24, PHQ-9 dadj = -0.29, GAD-7 dadj = -0.20, BPAQ dadj = 0.06, PANAS-PA dadj = 0.17).

CONCLUSIONS

Modernized collaborative care improved multiple mental health factors, highlighting the feasibility and longer-term benefits of blending collaborative care and digital mental health across racial, education, and income groups. Future implementation of such interventions could promote equitable access to high-quality care.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02458690.