title: Multimodal e-mental health treatment for depression: a feasibility trial.
abstract: BACKGROUND
  Internet interventions for depression have shown less than optimal adherence. This study describes the feasibility trial of a multimodal e-mental health intervention designed to enhance adherence and outcomes for depression. The intervention required frequent brief log-ins for self-monitoring and feedback as well as email and brief telephone support guided by a theory-driven manualized protocol.
  
  
  OBJECTIVE
  The objective of this feasibility trial was to examine if our Internet intervention plus manualized telephone support program would result in increased adherence rates and improvement in depression outcomes.
  
  
  METHODS
  This was a single arm feasibility trial of a 7-week intervention.
  
  
  RESULTS
  Of the 21 patients enrolled, 2 (9.5%) dropped out of treatment. Patients logged in 23.2 ± 12.2 times over the 7 weeks. Significant reductions in depression were found on all measures, including the Patient Health Questionnaire depression scale (PHQ-8) (Cohen's d = 1.96, P < .001), the Hamilton Rating Scale for Depression (d = 1.34, P < .001), and diagnosis of major depressive episode (P < .001).
  
  
  CONCLUSIONS
  The attrition rate was far lower than seen either in Internet studies or trials of face-to-face interventions, and depression outcomes were substantial. These findings support the feasibility of providing a multimodal e-mental health treatment to patients with depression. Although it is premature to make any firm conclusions based on these data, they do support the initiation of a randomized controlled trial examining the independent and joint effects of Internet and telephone administered treatments for depression.
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, United States. d-mohr@northwestern.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.forename: Jennifer
authors.initials: J
authors.lastname: Duffecy
authors.forename: Ling
authors.initials: L
authors.lastname: Jin
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Adam
authors.initials: A
authors.lastname: Lewis
authors.forename: Mark
authors.initials: M
authors.lastname: Begale
authors.forename: Martin
authors.initials: M
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010358:Patient Participation; D019114:Remote Consultation / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014481:United States