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      Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial

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          Abstract

          Background

          In the treatment of major depression, antidepressants are effective but not curative. Cognitive behavioral therapy (CBT) is also effective, alone or in combination with pharmacotherapy, but accessibility is a problem.

          Objective

          The aim is to evaluate the effectiveness of a smartphone CBT app as adjunctive therapy among patients with antidepressant-resistant major depression.

          Methods

          A multisite, assessor-masked, parallel-group randomized controlled trial was conducted in 20 psychiatric clinics and hospitals in Japan. Participants were eligible if they had a primary diagnosis of major depression and were antidepressant-refractory after taking one or more antidepressants at an adequate dosage for four or more weeks. After a 1-week run-in in which participants started the medication switch and had access to the welcome session of the app, patients were randomized to medication switch alone or to medication switch plus smartphone CBT app via the centralized Web system. The smartphone app, called Kokoro-app (“kokoro” means “mind” in Japanese), included sessions on self-monitoring, behavioral activation, and cognitive restructuring presented by cartoon characters. The primary outcome was depression severity as assessed by masked telephone assessors with the Patient Health Questionnaire-9 (PHQ-9) at week 9. The secondary outcomes included the Beck Depression Inventory-II (BDI-II) and Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER).

          Results

          In the total sample (N=164), 81 participants were allocated to the smartphone CBT in addition to medication change and 83 to medication change alone. In the former group, all but one participant (80/81, 99%) completed at least half, and 71 (88%) completed at least six of eight sessions. In the intention-to-treat analysis, patients allocated the CBT app scored 2.48 points (95% CI 1.23-3.72, P<.001; standardized mean difference 0.40) lower on PHQ-9 than the control at week 9. The former group also scored 4.1 points (95% CI 1.5-6.6, P=.002) lower on BDI-II and 0.76 points (95% CI –0.05 to 1.58, P=.07) lower on FIBSER. In the per-protocol sample (comfortable with the smartphone app, still symptomatic, and adherent to medication with mild or less side effects after run-in), the intervention group (n=60) scored 1.72 points (95% CI 0.25-3.18, P=.02) lower on PHQ-9, 3.2 points (95% CI –0.01 to 6.3, P=.05) lower on BDI-II, and 0.75 points (95% CI 0.03-1.47, P=.04) lower on FIBSER than the control (n=57). The treatment benefits were maintained up to week 17.

          Conclusions

          This is the first study to demonstrate the effectiveness of a smartphone CBT in the treatment of clinically diagnosed depression. Given the merits of the mobile mental health intervention, including accessibility, affordability, quality control, and effectiveness, it is clinically worthwhile to consider adjunctive use of a smartphone CBT app when treating patients with antidepressant-resistant depression. Research into its effectiveness in wider clinical contexts is warranted.

          Trial Registration

          Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik)

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          Most cited references38

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          Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.

          Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment. Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services. The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less. Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.
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            Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data.

            Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.

              To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. Survey; criterion standard. Four primary care clinics. A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians. PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/referral decisions. Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, kappa = 0.71; overall accuracy rate = 88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P < .005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated. PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.
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                Author and article information

                Contributors
                On behalf of : the FLATT Investigators
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                November 2017
                03 November 2017
                : 19
                : 11
                : e373
                Affiliations
                [01] 1 Mantani Mental Clinic Hiroshima Japan
                [02] 2 Aratama Kokorono Clinic Nagoya Japan
                [03] 3 Department of Health Promotion and Human Behavior School of Public Health, Graduate School of Medicine Kyoto University Kyoto Japan
                [04] 4 National Center of Neurology and Psychiatry Kodaira Japan
                [05] 5 Waseda Clinic Kani Japan
                [06] 6 Ginza Taimei Clinic Tokyo Japan
                [07] 7 Funayama Mental Clinic Nagoya Japan
                [08] 8 Department of Biostatistics School of Public Health, Graduate School of Medicine Kyoto University Kyoto Japan
                [09] 9 Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton, ON Canada
                [10] 10 Advanced Telecommunications Research Institute International Kyoto Japan
                Author notes
                Corresponding Author: Toshi A Furukawa furukawa@ 123456kuhp.kyoto-u.ac.jp
                Author information
                http://orcid.org/0000-0002-3775-483X
                http://orcid.org/0000-0002-7491-9701
                http://orcid.org/0000-0003-2159-3776
                http://orcid.org/0000-0001-9336-8813
                http://orcid.org/0000-0003-3656-5188
                http://orcid.org/0000-0002-1803-0318
                http://orcid.org/0000-0003-1238-2395
                http://orcid.org/0000-0001-8907-2470
                http://orcid.org/0000-0003-3637-2095
                http://orcid.org/0000-0002-7795-9995
                http://orcid.org/0000-0003-3146-3393
                Article
                v19i11e373
                10.2196/jmir.8602
                5695656
                29101095
                8157c8ab-b8e4-4588-a908-b3762ded14f0
                ©Akio Mantani, Tadashi Kato, Toshi A Furukawa, Masaru Horikoshi, Hissei Imai, Takahiro Hiroe, Bun Chino, Tadashi Funayama, Naohiro Yonemoto, Qi Zhou, Nao Kawanishi. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 03.11.2017.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 29 July 2017
                : 24 August 2017
                : 2 September 2017
                : 23 September 2017
                Categories
                Original Paper
                Original Paper

                Medicine
                major depressive disorder,pharmacotherapy-resistant depression,mobile phone app,cognitive behavioral therapy,ehealth

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