PMID- 22706833
OWN - NLM
STAT- MEDLINE
DCOM- 20120620
LR  - 20220331
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Print)
IS  - 0098-7484 (Linking)
VI  - 307
IP  - 21
DP  - 2012 Jun 6
TI  - 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.
PG  - 2278-85
LID - 10.1001/jama.2012.5588 [doi]
AB  - CONTEXT: Primary care is the most common site for the treatment of depression. 
      Most depressed patients prefer psychotherapy over antidepressant medications, but 
      access barriers are believed to prevent engagement in and completion of 
      treatment. The telephone has been investigated as a treatment delivery medium to 
      overcome access barriers, but little is known about its efficacy compared with 
      face-to-face treatment delivery. OBJECTIVE: To examine whether 
      telephone-administered cognitive behavioral therapy (T-CBT) reduces attrition and 
      is not inferior to face-to-face CBT in treating depression among primary care 
      patients. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial of 325 
      Chicago-area primary care patients with major depressive disorder, recruited from 
      November 2007 to December 2010. INTERVENTIONS: Eighteen sessions of T-CBT or 
      face-to-face CBT. MAIN OUTCOME MEASURES: The primary outcome was attrition 
      (completion vs noncompletion) at posttreatment (week 18). Secondary outcomes 
      included masked interviewer-rated depression with the Hamilton Depression Rating 
      Scale (Ham-D) and self-reported depression with the Patient Health 
      Questionnaire-9 (PHQ-9). RESULTS: Significantly fewer participants discontinued 
      T-CBT (n = 34; 20.9%) compared with face-to-face CBT (n = 53; 32.7%; P = .02). 
      Patients showed significant improvement in depression across both treatments (P < 
      .001). There were no significant treatment differences at posttreatment between 
      T-CBT and face-to-face CBT on the Ham-D (P = .22) or the PHQ-9 (P = .89). The 
      intention-to-treat posttreatment effect size on the Ham-D was d = 0.14 (90% CI, 
      -0.05 to 0.33), and for the PHQ-9 it was d = -0.02 (90% CI, -0.20 to 0.17). Both 
      results were within the inferiority margin of d = 0.41, indicating that T-CBT was 
      not inferior to face-to-face CBT. Although participants remained significantly 
      less depressed at 6-month follow-up relative to baseline (P < .001), participants 
      receiving face-to-face CBT were significantly less depressed than those receiving 
      T-CBT on the Ham-D (difference, 2.91; 95% CI, 1.20-4.63; P < .001) and the PHQ-9 
      (difference, 2.12; 95% CI, 0.68-3.56; P = .004). CONCLUSIONS: Among primary care 
      patients with depression, providing CBT over the telephone compared with 
      face-to-face resulted in lower attrition and close to equivalent improvement in 
      depression at posttreatment. At 6-month follow-up, patients remained less 
      depressed relative to baseline; however, those receiving face-to-face CBT were 
      less depressed than those receiving T-CBT. These results indicate that T-CBT 
      improves adherence compared with face-to-face delivery, but at the cost of some 
      increased risk of poorer maintenance of gains after treatment cessation. TRIAL 
      REGISTRATION: clinicaltrials.gov Identifier: NCT00498706.
FAU - Mohr, David C
AU  - Mohr DC
AD  - Department of Preventive Medicine, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois 60611, USA. d-mohr@northwestern.edu
FAU - Ho, Joyce
AU  - Ho J
FAU - Duffecy, Jenna
AU  - Duffecy J
FAU - Reifler, Douglas
AU  - Reifler D
FAU - Sokol, Leslie
AU  - Sokol L
FAU - Burns, Michelle Nicole
AU  - Burns MN
FAU - Jin, Ling
AU  - Jin L
FAU - Siddique, Juned
AU  - Siddique J
LA  - eng
SI  - ClinicalTrials.gov/NCT00498706
GR  - R01 MH059708/MH/NIMH NIH HHS/United States
GR  - UL1 RR025741/RR/NCRR NIH HHS/United States
GR  - UL1 TR000150/TR/NCATS NIH HHS/United States
GR  - R01-MH059708/MH/NIMH NIH HHS/United States
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - IM
CIN - Ann Intern Med. 2012 Sep 18;157(6):JC3-12. PMID: 22986404
CIN - JAMA. 2012 Sep 19;308(11):1090-1; author reply 1091. PMID: 22990260
MH  - Adult
MH  - Cognitive Behavioral Therapy/*methods
MH  - Depressive Disorder, Major/*therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Compliance
MH  - Physician-Patient Relations
MH  - *Primary Health Care
MH  - Severity of Illness Index
MH  - *Telephone
MH  - Treatment Outcome
PMC - PMC3697075
MID - NIHMS474961
COIS- Conflict of Interest Disclosures: All authors have completed and submitted the 
      ICMJE Form for Disclosure of Potential Conflicts of Interest and none were 
      reported.
EDAT- 2012/06/19 06:00
MHDA- 2012/06/21 06:00
PMCR- 2013/07/01
CRDT- 2012/06/19 06:00
PHST- 2012/06/19 06:00 [entrez]
PHST- 2012/06/19 06:00 [pubmed]
PHST- 2012/06/21 06:00 [medline]
PHST- 2013/07/01 00:00 [pmc-release]
AID - 1172045 [pii]
AID - 10.1001/jama.2012.5588 [doi]
PST - ppublish
SO  - JAMA. 2012 Jun 6;307(21):2278-85. doi: 10.1001/jama.2012.5588.