The aim of this pilot grant is to develop a telemental health intervention for depression that integrates web-based cognitive behavioral skills training with therapist motivational support and outreach, and to develop procedures for a larger Phase III clinical trial. Major depressive disorder (MDD) is common, with 12-month prevalence rates estimated to be between 6.6-10.3% 1, 2. While many depressed patients state they would prefer psychological treatment to pharmacotherapy, substantial barriers to care exist, including cost, practical barriers such as time constraints and transportation, emotional barriers such as stigma, decreased motivation associated with depression itself, physical disability, and lack of availability of services. The development and validation of telemental health interventions as a means of overcoming these barriers has been widely called for by the NIMH, the 2003 President's New Freedom Commission on Mental Health, and leaders in the field of mental health. Two telecommunications technologies have been explored to deliver telemental health interventions: telephone-administered psychotherapy and web based internet therapy. Telephone administered psychotherapy has repeatedly been shown to produce significant reductions in depression as well as very low rates of attrition (mean attrition rate = 7.5%). Internet-based cognitive behavior therapy (ICBT), which provides automated CBT skills-training, has considerable potential. However, outcomes have been only small to moderate, in part because many people do not return to the website. To date, research has examined telemental health interventions using primarily one methodology or the other. While each of these technologies has advantages, intervention programs relying primarily on one technology are limited by the disadvantages of that technology. We are proposing to develop an integrated telemental health intervention (ITHI) that utilizes I-CBT, telephone support and e-mail. The first 12 months would focus on the development of the I-CBT website. The remainder of the study would pilot three treatment arms, ITHI, I-CBT and a waitlist control. All assessment and monitoring procedures would also be piloted.
