Rodger Kessler, PhD, ABPP
In patients with major depressive disorder (MDD),
does telephone-based cognitive–behavioral therapy (CBT) improve treatment
adherence and have better efficacy than face-to-face CBT?
Randomized controlled trial (RCT).
Blinded* (outcome assessors for Hamilton
Depression [Ham-D] Rating Scale).
18 weeks and 6 months.
2 academic general internal medicine and 4
primary care clinics in metropolitan Chicago, Illinois, USA.
325 English-speaking patients ≥ 18 years
of age (mean age 48 y, 78% women) who had MDD (Ham-D score ≥ 16).
Exclusion criteria were vision or hearing impairment preventing participation;
severe psychiatric disorder; depression of organic cause; severe alcohol or
substance abuse; dementia; suicidality; receiving or planning to receive
individual psychotherapy; or initiation of antidepressant pharmacotherapy in
the past 10 days.
(n = 163) or face-to-face CBT
(n = 162). CBT protocol was the same for
both groups and comprised eighteen 45-minute sessions (2 sessions/wk for 2 wk,
then 12 weekly sessions, then 2 booster sessions over 4 wk).
Primary outcome was nonadherence to treatment
(completion of < 18 sessions). Secondary outcomes were depression
severity (17-item Ham-D and Patient Heath Questionaire-9 [PHQ-9]), MDD (Mini
International Neuropsychiatric Interview), and full remission (abbreviated
7-item Ham-D scale).
100% for nonadherence (intention-to-treat
Nonadherence to treatment was lower in the
telephone group than in the face-to-face group (Table). Groups did not differ
for depression severity at 18 weeks, but the telephone group had more severe
depression at 6 months (mean difference Ham-D score 2.91,
P < 0.001 and PHQ-9 2.12,
P = 0.004). Groups did not differ for MDD
at 18 weeks or 6 months or for remission at 18 weeks (Table); remission was
lower in the telephone group at 6 months (Table).
In patients with major depressive disorder,
cognitive–behavioral therapy (CBT) by telephone improved treatment
adherence compared with face-to-face CBT. Groups had similar rates of major
depressive disorder and remission at 18 weeks, but remission rate was lower in
the telephone group at 6 months.
Telephone vs face-to-face (FTF)
cognitive–behavioral therapy in patients with major depressive disorder
†NS = not significant; RBR = relative
benefit reduction; other abbreviations defined in
Glossary. RRR, RRI,
RBR, NNT, NNH, and CI calculated using estimated numbers of patients based on
event rates in article and assuming 100% follow-up.
‡Based on Mini International
§Based on 7-item abbreviated Hamilton
Depression Rating Scale.
Kessler R. CBT by telephone for depression improved adherence
compared with face-to-face CBT in primary care. Ann Intern Med. ;157:JC3–12. doi: 10.7326/0003-4819-157-6-201209180-02012
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Published: Ann Intern Med. 2012;157(6):JC3-12.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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