Effectiveness and cost-effectiveness of blended cognitive behavioral therapy in clinically depressed adolescents: Protocol for a pragmatic quasi-experimental controlled trial

Sanne P.A. Rasing, Yvonne A.J. Stikkelbroek, Heleen Riper, Maja Dekovic, Maaike H. Nauta, Carmen D. Dirksen, Daan H.M. Creemers, Denise H.M. Bodden

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: Cognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of adolescents still have depressive symptoms after treatment, and 57% drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk. Objective: In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents. Methods: A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups. Results: The primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT. Conclusions: This study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed.

Original languageEnglish
Article numbere13434
Pages (from-to)1-13
Number of pages13
JournalJournal of Medical Internet Research
Volume21
Issue number10
DOIs
Publication statusPublished - 7 Oct 2019

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Cognitive Therapy
Cost-Benefit Analysis
Depression
Therapeutics
Depressive Disorder
Clinical Protocols
Suicide
Mental Health
Psychiatric Hospitals
Feasibility Studies
Psychopathology
Emotions
Randomized Controlled Trials
Alcohols
Quality of Life
Delivery of Health Care
Costs and Cost Analysis

Keywords

  • Adolescents
  • Blended
  • Cognitive behavioral therapy
  • Cost-effectiveness
  • Depression
  • Effectiveness
  • EHealth
  • Major depressive disorder
  • Online

Cite this

Rasing, Sanne P.A. ; Stikkelbroek, Yvonne A.J. ; Riper, Heleen ; Dekovic, Maja ; Nauta, Maaike H. ; Dirksen, Carmen D. ; Creemers, Daan H.M. ; Bodden, Denise H.M. / Effectiveness and cost-effectiveness of blended cognitive behavioral therapy in clinically depressed adolescents : Protocol for a pragmatic quasi-experimental controlled trial. In: Journal of Medical Internet Research. 2019 ; Vol. 21, No. 10. pp. 1-13.
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title = "Effectiveness and cost-effectiveness of blended cognitive behavioral therapy in clinically depressed adolescents: Protocol for a pragmatic quasi-experimental controlled trial",
abstract = "Background: Cognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50{\%} of adolescents still have depressive symptoms after treatment, and 57{\%} drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk. Objective: In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents. Methods: A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups. Results: The primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT. Conclusions: This study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed.",
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Effectiveness and cost-effectiveness of blended cognitive behavioral therapy in clinically depressed adolescents : Protocol for a pragmatic quasi-experimental controlled trial. / Rasing, Sanne P.A.; Stikkelbroek, Yvonne A.J.; Riper, Heleen; Dekovic, Maja; Nauta, Maaike H.; Dirksen, Carmen D.; Creemers, Daan H.M.; Bodden, Denise H.M.

In: Journal of Medical Internet Research, Vol. 21, No. 10, e13434, 07.10.2019, p. 1-13.

Research output: Contribution to JournalArticleAcademicpeer-review

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T1 - Effectiveness and cost-effectiveness of blended cognitive behavioral therapy in clinically depressed adolescents

T2 - Protocol for a pragmatic quasi-experimental controlled trial

AU - Rasing, Sanne P.A.

AU - Stikkelbroek, Yvonne A.J.

AU - Riper, Heleen

AU - Dekovic, Maja

AU - Nauta, Maaike H.

AU - Dirksen, Carmen D.

AU - Creemers, Daan H.M.

AU - Bodden, Denise H.M.

PY - 2019/10/7

Y1 - 2019/10/7

N2 - Background: Cognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of adolescents still have depressive symptoms after treatment, and 57% drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk. Objective: In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents. Methods: A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups. Results: The primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT. Conclusions: This study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed.

AB - Background: Cognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of adolescents still have depressive symptoms after treatment, and 57% drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk. Objective: In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents. Methods: A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups. Results: The primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT. Conclusions: This study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed.

KW - Adolescents

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KW - Cognitive behavioral therapy

KW - Cost-effectiveness

KW - Depression

KW - Effectiveness

KW - EHealth

KW - Major depressive disorder

KW - Online

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