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

Abstract

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 d_adj = -0.57, PHQ-9 d_adj = -0.63, GAD-7 d_adj = -0.50, BPAQ d_adj = -0.17, PANAS-PA d_adj = 0.41), and decreased over the follow-up period (24 months: SCL-20 d_adj = -0.24, PHQ-9 d_adj = -0.29, GAD-7 d_adj = -0.20, BPAQ d_adj = 0.06, PANAS-PA d_adj = 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.

Keywords: Anger; Anxiety; Clinical trial; Collaborative care; Depression; Digital health.