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Stepping Up: Predictors of ‘Stepping’ within an iCBT Stepped-Care Intervention for Depression

Author

Listed:
  • Jennifer Nicholas

    (Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA)

  • Kathryn E. Ringland

    (Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
    Department of Communication Studies, Northwestern University, Chicago, IL 60611, USA)

  • Andrea K. Graham

    (Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
    Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA)

  • Ashley A. Knapp

    (Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA)

  • Emily G. Lattie

    (Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
    Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA)

  • Mary J. Kwasny

    (Biostatistics Collaboration Center, Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA)

  • David C. Mohr

    (Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA)

Abstract

Internet-based cognitive behavioral therapy (iCBT) may overcome barriers to mental health care and has proven efficacious. However, this approach currently exists outside the existing mental health care delivery system. Stepped care is a proposed framework for integrating digital mental health (DMH) into health systems by initiating iCBT and “stepping up” care to a more intensive intervention should iCBT prove ineffective. This study explores pre-treatment factors associated with reaching stepping criteria among patients receiving iCBT. This exploratory analysis of a stepped care arm of a larger randomized trial examined participants who were stepped to a more intensive intervention if they did not respond to iCBT. The association of pre-treatment factors on stepping were examined using Kruskal–Wallis and Chi-square tests. One-fifth of the 151 participants met criteria for stepping within the 20-week treatment period. Only pre-treatment depression severity and treatment preference were associated with increased likelihood of stepping ( p = 0.049 and 0.048, respectively). The low number of individuals who stepped provides support for iCBT as an effective, low intensity treatment for depression. The modest association of pre-treatment depression and preference to not receive iCBT may be useful in identifying patients who are less likely to respond.

Suggested Citation

  • Jennifer Nicholas & Kathryn E. Ringland & Andrea K. Graham & Ashley A. Knapp & Emily G. Lattie & Mary J. Kwasny & David C. Mohr, 2019. "Stepping Up: Predictors of ‘Stepping’ within an iCBT Stepped-Care Intervention for Depression," IJERPH, MDPI, vol. 16(23), pages 1-8, November.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:23:p:4689-:d:290615
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    Cited by:

    1. Patricia Otero & Isabel Hita & Ángela J. Torres & Fernando L. Vázquez, 2020. "Brief Psychological Intervention Through Mobile App and Conference Calls for the Prevention of Depression in Non-Professional Caregivers: A Pilot Study," IJERPH, MDPI, vol. 17(12), pages 1-15, June.

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