Web-based CBT for depression with and without telephone tracking in a national helpline: Secondary outcomes from a randomized controlled trial

Abstract

Background: An earlier report indicated that callers to a telephone counseling service benefited from the addition of an evidence-based Web intervention for depression. It is not known whether the Web intervention would also lower alcohol use and stigma, or improve quality of life and knowledge of depression and its treatments. Objective: To report the secondary outcomes of a trial of a Web-based cognitive behavior therapy (CBT) intervention for depression, including hazardous alcohol use, quality of life, stigma, depression literacy, and CBT literacy. Methods: We recruited a sample of 155 callers to Lifeline, a national telephone counseling service in Australia, who met the criteria for moderate to high psychological distress. Participants were randomly assigned to 1 of 4 conditions: (1) Web CBT plus weekly telephone tracking, (2) Web CBT only, (3) weekly telephone tracking only, and (4) neither Web CBT nor telephone tracking. Participants were assessed at preintervention, postintervention, and 6 and 12 months postintervention. Results: At postintervention, participants who completed the Web intervention either with or without telephone support had lower levels of haza dous alcohol use (without tracking: P=.008, effect size=0.23; with tracking: P=.003, effect size=0.26), improved quality of life (without tracking: P=.001, effect size=0.81; with tracking: P=.009, effect size=0.63), and improved CBT literacy (without tracking: P=.01, effect size=0.71; with tracking: P < .001, effect size = 0.80) compared with those who did not receive the Web intervention or telephone support. Results for quality of life and CBT literacy were maintained at 6- and 12-month’s follow-up, but differences in hazardous alcohol use were not significantly different between conditions at 6 and 12 months. Although omnibus tests for depression literacy and stigma were nonsignificant, contrasts revealed that those in theWeb-only condition showed significantly lower levels of stigma than participants in the control condition at postintervention. This was true for participants in the Web-only and Web plus tracking conditions at 6 months. Similarly, those in the Web-only and Web plus tracking conditions had significantly higher depression literacy at postintervention, and this was maintained in the Web-only condition at 6-months’ follow-up. No significant differences were found in depression literacy and stigma between conditions at 12 months. Conclusions: Evidence-based Web interventions for depression can be effective not only in reducing depression symptoms but also in improving other health outcomes, including quality of life, hazardous alcohol use, and knowledge about effective strategies for depression self-management.