Prospective acceptability of digital therapy for major depressive disorder in France: results of a first national multicentric real-life study (Preprint)

Abstract

Major depressive disorder is one of the leading causes of disability, worldwide. Recently, WHO underlined the negative impact of recent crises (COVID-19 pandemic, war in Ukraine, economic crisis). Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains scarce in France due to limited availability of trained clinicians, high cost for patient in a context of non-reimbursement and fear of stigmatization. Therefore, online blended psychological treatment such as deprexis® could increase access to care for people with depression. It presents several advantages such as easy access, scalability, and a proven efficacy .

This study aims to evaluate real-life acceptability of a deprexis® for people with depression in France outside a reimbursement pathway.

DARE was as a multicentric cross-sectional study in which deprexis® was suggested to any patient meeting the inclusion criteria over the fixed inclusion period June 2022-March 2023. Inclusion criteria was: 1/ depression, 2/ age between 18 and 65 years, 3/ speak French sufficiently, 4/ access to Internet with a device to connect to deprexis® platform. Exclusion criteria was past or actual diagnosis bipolar disorder, psychotic symptoms and/or suicidal thoughts the during current episode. Main objective is to measure prospective acceptability of deprexis® a new digital therapy. Secondary objectives are to study 1/ differences in acceptability according to type of center (Hospital based, Community Based or private practice) and type of practitioners (psychiatrists or psychologists), 2/ differences in acceptability according to severity’s level (evaluated with PHQ 9), 3/ differences in acceptability according to administration or not of a treatment (including psychotherapy), 4/ differences in acceptability according to prescriber's profile (age, sex, place and type of practice), 5/ identification of reasons for refusal , and 6/ analyze refusal rate over time. All investigators received a video-based training on deprexis® before inclusion to make sure they all have same level of information and understanding on the program.

245 patients were eligible (56,3% women and 56,3% single. Mean age 40.7+-14.1 years. 78% had a moderate to severe depression (according to PHQ-9). 33,9% of the patients accepted the idea of using deprexis® and the main reason of refusal was the financial one with 83.3 %. A multivariate logistic regression identified factors that may favor acceptability of deprexis®, marital status, concomitant treatment with anti-depressive medication or anxiolytics.

DARE will allow to have a better understanding of acceptability of a digital therapy in France and identifying factors influencing it in a natural setting.