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2019 HSR&D/QUERI National Conference Abstract

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1068 — Effectiveness of Veteran Peer-Assisted Computerized Cognitive Behavioral Therapy for Depression

Lead/Presenter: Paul Pfeiffer,  COIN - Ann Arbor
All Authors: Pfeiffer PN (VA Ann Arbor Center for Clinical Management Research, University of Michigan), Abraham K (VA Ann Arbor Center for Clinical Management Research, University of Detroit Mercy), Benn-Burton W (John D. Dingell VA Medical Center) Emerson L (VA Ann Arbor Center for Clinical Management Research) Ganoczy D (VA Ann Arbor Center for Clinical Management Research) Houck M (Battle Creek VA Medical Center) Kim HM (VA Ann Arbor Center for Clinical Management Research, Center for Statistical Consultation and Research, University of Michigan) Nelson B (VA Ann Arbor Healthcare System, University of Michigan) Pope B (Battle Creek VA Medical Center) Walters H (VA Ann Arbor Center for Clinical Management Research) Valenstein M (VA Ann Arbor Center for Clinical Management Research, University of Michigan)

Objectives:
Evidence-based psychotherapy for depression is often limited by provider availability, transportation concerns, and patient acceptability. Computer-based cognitive behavioral therapy (cCBT) addresses many of these barriers, but patient engagement in cCBT programs is low in the absence of human support. This study determined whether cCBT augmented by a Peer Support Specialist is effective for improving depression symptoms compared to minimally enhanced usual VA primary care.

Methods:
330 VA primary care patients with a diagnosis of depression and a PHQ-9 score ? 10 were recruited from 3 Midwestern VA Medical Centers and 2 Community-based Outpatient Clinics and were randomized to receive either peer-supported cCBT (PS-cCBT) or usual primary care enhanced by receipt of a depression workbook (EUC). Participants assigned to PS-cCBT received access to the 8-module online Beating the Blues cCBT program and weekly phone support from a Veteran Peer Support Specialist for 3 months. Primary outcomes were the Quick Inventory of Depression Symptoms (QIDS-SR), mental component subscale of the Veterans Rand health survey (VR-12), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Recovery Assessment Scale (RAS) measured at baseline, 3, and 6 months and analyzed using linear mixed effects models.

Results:
There were no significant differences between groups at baseline except for minor differences in education. 72% of patients were assessed at 3 months and 66% at 6 months. The interaction between study arm and time was significant such that participants in the PS-cCBT arm experienced greater reductions in depression symptoms (QIDS-SR: b = -1.4; 95% CI: -2.5, -0.3; p = .01) and greater improvements in quality of life (Q-LES-Q: b = 2.6; 95% CI: 0.5, 4.8; p = .02) and recovery (RAS: b = 3.6; 95% CI: 0.9, 6.2; p = .01) at 3 months and greater recovery at 6 months (b = 4.5; 95% CI: 1.2, 7.7; p = .01).

Implications:
PS-cCBT was effective at improving depression symptoms and other patient-centered outcomes over 3 months. There were significant differences only for recovery after 6 months.

Impacts:
VA should consider supporting implementation of peer-supported computerized cognitive behavioral therapy for primary care treatment of depression.