Impact of Digital Decision Aid in Choosing between Face-to-Face and Guided Internet-based Psychotherapy for Depression: A randomized controlled trial (Preprint)

Abstract

The expansion of e-mental health services offers diverse treatment options, as well as possibilities for individuals to make informed decisions about their care.

This study evaluates the effects of a decision aid (DA) for users in choosing between Internet-based and in-person psychotherapy, which aligns with NICE guidelines’ emphasis on shared decision-making in health services.

A web based RCT was conducted with 148 participants exhibiting depressive symptoms above the clinical threshold. Participants were randomly assigned to either the DA intervention group or the attention control group. The DA group underwent a brief interactive self-directed web-based DA. The attention control involved an unguided web search on mental health information. The outcome measures included decision conflict, stage of decision making, and satisfaction with the decision, attitudes, and likelihood of utilizing the mentioned services.

A time-by-intervention interaction in ANOVA, F (1,136) =9.56, p < 0.002, 95% CI = [0.0086,0.16]) indicated that decisional conflict reduced more significantly in DA group than control. Chi-squared tests indicated significantly higher percentage of the participants in the DA group than the control group agreed that they "know the benefits and harms of each option", were "clear about which benefits and risks matter most, and "had enough support and advice to make a choice". In addition, participants who used the DA, preferred (OR: 2.26, p=.024, 95% CI: 1.11,4.60) and were more likely to use (OR: 2.53, p=.006, 95% CI: 1.13,4.92) guided Internet-based psychotherapy than participants who searched mental health information on the web by themselves.

This study demonstrates the potential impact and value of DA in assisting individuals with depressive symptoms in making informed choices related to e-mental health. Coordinated investment in DA may facilitate uptake of digital mental health services. Future research should explore the behavioural and long-term impact and generalizability of decision aids in applied settings.

NCT05477420