Engagement and outcomes for a computerised cognitive-behavioural therapy intervention for anxiety and depression in African Americans

Charles R Jonassaint, Patrice Gibbs, Bea Herbeck Belnap, Jordan F Karp, Kaleab K Abebe, Bruce L Rollman, Charles R Jonassaint, Patrice Gibbs, Bea Herbeck Belnap, Jordan F Karp, Kaleab K Abebe, Bruce L Rollman

Abstract

Background: Computerised cognitive-behavioural therapy (CCBT) helps improve mental health outcomes in White populations. However, no studies have examined whether CCBT is acceptable and beneficial for African Americans.

Aims: We studied differences in CCBT use and self-reported change in depression and anxiety symptoms among 91 African Americans and 499 White primary care patients aged 18-75, enrolled in a randomised clinical trial of collaborative care embedded with an online treatment for depression and anxiety.

Method: Patients with moderate levels of mood and/or anxiety symptoms (PHQ-9 or GAD-7≥10) were randomised to receive either care-manager-guided access to the proven-effective Beating the Blues® CCBT programme or usual care from their primary care doctor.

Results: Compared with White participants, African Americans were less likely to start the CCBT programme (P=0.01), and those who did completed fewer sessions and were less likely to complete the full programme (P=0.03). Despite lower engagement, however, African Americans who started the CCBT programme experienced a greater decrease in self-reported depressive symptoms (estimated 8-session change: -6.6 v. -5.5; P=0.06) and similar decrease in anxiety symptoms (-5.3 v. -5.6; P=0.80) compared with White participants.

Conclusions: CCBT may be an efficient and scalable first-step to improving minority mental health and reducing disparities in access to evidence-based healthcare.

Declaration of interest: None.

Copyright and usage: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Figures

Fig. 1. Decline in average PHQ-9 scores…
Fig. 1. Decline in average PHQ-9 scores at each session by race. AA=African American; PHQ-9=9-item Patient Health Questionnaire. PHQ-9 scores were self-entered at the beginning of each CCBT session. Changes in depression and anxiety symptom outcomes were assessed using linear mixed models controlling for age, gender, education, baseline symptom and baseline pharmacotherapy use. We first evaluated whether the change in symptom outcome across the eight sessions differentiated by race (i.e. session-by-race interaction). Where interaction effects were non-significant, they were removed from the model and only the main effect reported.

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Source: PubMed

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