title: Engagement and outcomes for a computerised cognitive-behavioural therapy intervention for anxiety and depression in African Americans.
abstract: BACKGROUND
  Computerised cognitive-behavioural therapy (CCBT) helps improve mental health outcomes in White populations. However, no studies have examined whether CCBT is acceptable and beneficial for African Americans.
  
  
  OBJECTIVE
  We studied differences in CCBT use and self-reported change in depression and anxiety symptoms among 91 African Americans and 499 White primary care patients aged 18-75, enrolled in a randomised clinical trial of collaborative care embedded with an online treatment for depression and anxiety.
  
  
  METHODS
  Patients with moderate levels of mood and/or anxiety symptoms (PHQ-9 or GAD-7≥10) were randomised to receive either care-manager-guided access to the proven-effective Beating the Blues®CCBT programme or usual care from their primary care doctor.
  
  
  RESULTS
  Compared with White participants, African Americans were less likely to start the CCBT programme (P=0.01), and those who did completed fewer sessions and were less likely to complete the full programme (P=0.03). Despite lower engagement, however, African Americans who started the CCBT programme experienced a greater decrease in self-reported depressive symptoms (estimated 8-session change: -6.6v.-5.5;P=0.06) and similar decrease in anxiety symptoms (-5.3v.-5.6;P=0.80) compared with White participants.
  
  
  CONCLUSIONS
  CCBT may be an efficient and scalable first-step to improving minority mental health and reducing disparities in access to evidence-based healthcare.
  
  
  BACKGROUND
  None.
  © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
authors.affiliation: , PhD, MHS, Center for Behavioral Health and Smart Technology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Jonassaint
authors.affiliation: , MS, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Patrice
authors.initials: P
authors.lastname: Gibbs
authors.affiliation: , Dr Biol Hum, Center for Behavioral Health and Smart Technology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Bea Herbeck
authors.initials: BH
authors.lastname: Belnap
authors.affiliation: , MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Health System, Pittsburgh, PA, USA.
authors.forename: Jordan F
authors.initials: JF
authors.lastname: Karp
authors.affiliation: , PhD, Center for Clinical Trials & Data Coordination, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Kaleab K
authors.initials: KK
authors.lastname: Abebe
authors.affiliation: , MD, MPH, Center for Behavioral Health and Smart Technology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman