TY - JOUR
AU - L. B. Leung
AU - C. E. Brayton
AU - S. Hovsepian
AU - M. A. Karakashian
AU - K. Chu
AU - N. J. Jackson
AU - P. G. Shekelle
AU - A. B. Hamilton
AU - E. M. Yano
AU - B. L. Rollman
AU - A. S. Young
A1 - 
AB - OBJECTIVE: To examine the feasibility, acceptability, and potential health effects of computerized cognitive behavioral therapy-enhanced collaborative care (cCBT-CC) versus usual primary care (UC). BACKGROUND: Internet-based cCBT can effectively treat depression but is not widely used, including in the Veterans Health Administration where it was freely available for veterans. We adapted pre-existing depression collaborative care models using implementation and user-centered design strategies to facilitate cCBT implementation. METHODS: This pilot randomized controlled trial (RCT) included 57 VA primary care patients to cCBT-CC or UC. Participants had Patient Health Questionnaire (PHQ-9) scores of 10+. Those with serious mental illness (e.g., bipolar depression, schizophrenia) and active suicidality were excluded. Intervention patients received tailored Vets Prevail cCBT accompanied by collaborative care manager support, overseen by psychiatry and primary care. UC offered collaborative care services and digital mental health tools at baseline. Feasibility (patient reach, provider adoption, intervention implementation), acceptability (CSQ-8), and potential effectiveness (PHQ-9) data was collected at baseline and 3-months by a blinded study team member. RESULTS: Participants (cCBT-CC n = 29, UC n = 28) were 50 years old (mean); 70 % men; 32 % White, 32 % Hispanic, 25 % Black; 21 % homeless-experienced. Mean baseline PHQ-9 scores were 15.1 (SD = 5.0); 39 % reported suicidal thoughts/behaviors. 72 % of 94 primary care providers, from 6 out of the 8 participating clinics, helped support their patients' participation. cCBT-CC participants received 4 care manager check-ins over 33 days totaling 113 min (64 % clinical; 36 % technical), on average. They completed mean 6.7 out of 11 cCBT lessons. Participants in the cCBT-CC arm experienced a statistically (not clinically) significant decline in the primary outcome of depression (Δ = -2.5; p = 0.02) symptoms from pretreatment to posttreatment. There was a greater, albeit non-significant, decrease in PHQ-9 scores among cCBT-CC participants over 3-months, compared to UC participants (Δ = -2.8; 95 % CI = -5.6, -0.01; p = 0.05). CONCLUSIONS: cCBT-enhanced collaborative care appeared feasible, acceptable, and possibly effective in treating primary care patients with depression.
AD - Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90095, USA. Electronic address: lleung@mednet.ulca.edu.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA. Electronic address: catherine.brayton@va.gov.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA. Electronic address: sona.hovsepian@va.gov.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA. Electronic address: michael.karakashian@va.gov.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA.; Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA 90095, USA.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA 90095, USA. Electronic address: paul.shekelle@va.gov.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90095, USA. Electronic address: alison.hamilton@va.gov.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA 90095, USA; Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr., Los Angeles, CA 90095, USA. Electronic address: eyano@ucla.edu.; Division of General Internal Medicine, University of Pittsburgh School of Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, USA; Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.; Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90095, USA; VA VISN 22 Mental Illness Research, Education, and Clinical Center, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA. Electronic address: ayoung@ucla.edu.
AN - 40763603
BT - Gen Hosp Psychiatry
C5 - HIT & Telehealth; Healthcare Disparities
DA - Sep-Oct
DO - 10.1016/j.genhosppsych.2025.07.014
DP - NLM
ET - 20250729
JF - Gen Hosp Psychiatry
LA - eng
N2 - OBJECTIVE: To examine the feasibility, acceptability, and potential health effects of computerized cognitive behavioral therapy-enhanced collaborative care (cCBT-CC) versus usual primary care (UC). BACKGROUND: Internet-based cCBT can effectively treat depression but is not widely used, including in the Veterans Health Administration where it was freely available for veterans. We adapted pre-existing depression collaborative care models using implementation and user-centered design strategies to facilitate cCBT implementation. METHODS: This pilot randomized controlled trial (RCT) included 57 VA primary care patients to cCBT-CC or UC. Participants had Patient Health Questionnaire (PHQ-9) scores of 10+. Those with serious mental illness (e.g., bipolar depression, schizophrenia) and active suicidality were excluded. Intervention patients received tailored Vets Prevail cCBT accompanied by collaborative care manager support, overseen by psychiatry and primary care. UC offered collaborative care services and digital mental health tools at baseline. Feasibility (patient reach, provider adoption, intervention implementation), acceptability (CSQ-8), and potential effectiveness (PHQ-9) data was collected at baseline and 3-months by a blinded study team member. RESULTS: Participants (cCBT-CC n = 29, UC n = 28) were 50 years old (mean); 70 % men; 32 % White, 32 % Hispanic, 25 % Black; 21 % homeless-experienced. Mean baseline PHQ-9 scores were 15.1 (SD = 5.0); 39 % reported suicidal thoughts/behaviors. 72 % of 94 primary care providers, from 6 out of the 8 participating clinics, helped support their patients' participation. cCBT-CC participants received 4 care manager check-ins over 33 days totaling 113 min (64 % clinical; 36 % technical), on average. They completed mean 6.7 out of 11 cCBT lessons. Participants in the cCBT-CC arm experienced a statistically (not clinically) significant decline in the primary outcome of depression (Δ = -2.5; p = 0.02) symptoms from pretreatment to posttreatment. There was a greater, albeit non-significant, decrease in PHQ-9 scores among cCBT-CC participants over 3-months, compared to UC participants (Δ = -2.8; 95 % CI = -5.6, -0.01; p = 0.05). CONCLUSIONS: cCBT-enhanced collaborative care appeared feasible, acceptable, and possibly effective in treating primary care patients with depression.
PY - 2025
SN - 0163-8343
SP - 223
EP - 233+
ST - Adapting depression collaborative care models to increase uptake of computerized cognitive behavioral therapy at the VA: A pilot randomized controlled trial
T1 - Adapting depression collaborative care models to increase uptake of computerized cognitive behavioral therapy at the VA: A pilot randomized controlled trial
T2 - Gen Hosp Psychiatry
TI - Adapting depression collaborative care models to increase uptake of computerized cognitive behavioral therapy at the VA: A pilot randomized controlled trial
U1 - HIT & Telehealth; Healthcare Disparities
U3 - 10.1016/j.genhosppsych.2025.07.014
VL - 96
VO - 0163-8343
Y1 - 2025
ER -