Hadjistavropoulos Heather D, Peynenburg Vanessa, Mehta Swati, Adlam Kelly, Nugent Marcie, Gullickson Kirsten M, Titov Nickolai, Dear Blake
Department of Psychology, University of Regina, Regina, SK, Canada.
Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada.
JMIR Ment Health. 2020 Feb 4;7(2):e16005. doi: 10.2196/16005.
Anxiety and depression are leading causes of disability but are often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care. ICBT has been found to be efficacious in research trials and routine care, but there is limited research of ICBT when it is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations.
The aim of this study was to examine ICBT engagement, treatment satisfaction, and effectiveness among individuals involved with 2 insurance companies. The 2 samples were benchmarked against published outcomes from a publicly funded (PF) ICBT clinic.
Individuals who were on or recently in receipt of disability benefits and were either insurance company (IC) employees (n=21) or IC plan members (n=19) were referred to ICBT funded by the respective insurance companies. Outcomes were benchmarked against outcomes of ICBT obtained in a PF ICBT clinic, with clients in the clinic divided into those who reported no involvement with insurance companies (n=414) and those who were on short-term disability (n=44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting anxiety and depression. Engagement was assessed using completion rates, log-ins, and emails exchanged. Treatment satisfaction was assessed posttreatment. Depression, anxiety, and disability measures were administered pretreatment, posttreatment, and at 3 months.
All samples showed high levels of ICBT engagement and treatment satisfaction. IC employees experienced significant improvement at posttreatment (depression d=0.77; anxiety d=1.13; and disability d=0.91) with outcomes maintained at 3 months. IC plan members, who notably had greater pretreatment disability than the other samples, experienced significant moderate effects at posttreatment (depression d=0.58; anxiety d=0.54; and disability d=0.60), but gains were not maintained at 3 months. Effect sizes at posttreatment in both IC samples were significantly smaller than in the PF sample who reported no insurance benefits (depression d=1.14 and anxiety d=1.30) and the PF sample who reported having short-term disability benefits (depression d=0.95 and anxiety d=1.07). No difference was seen in effect sizes among IC employees and the PF samples on disability. However, IC plan members experienced significantly smaller effects on disability d=0.60) compared with the PF sample with no disability benefits d=0.90) and those on short-term disability benefits d=0.94).
Many clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pretreatment disability. Small sample sizes in the IC groups are a limitation. Directions for research related to ICBT funded by insurance companies have been described.
焦虑和抑郁是导致残疾的主要原因，但往往治疗不足。互联网认知行为疗法（ICBT）通过克服获得护理的障碍来改善治疗途径。ICBT在研究试验和常规护理中已被证明是有效的，但当保险公司为正在领取或最近领取残疾福利或便利的客户推荐并资助ICBT时，相关研究有限。
本研究的目的是调查参与两家保险公司的个体对ICBT的参与度、治疗满意度和有效性。将这两个样本与一家公共资助（PF）ICBT诊所公布的结果进行对比。
正在领取或最近领取残疾福利的个体，他们要么是保险公司（IC）员工（n = 21），要么是IC计划成员（n = 19），被转介接受各自保险公司资助的ICBT。将结果与在PF ICBT诊所获得的ICBT结果进行对比，诊所中的客户分为未报告与保险公司有任何关联的客户（n = 414）和领取短期残疾福利的客户（n = 44）。所有客户都接受了相同的为期8周、由治疗师辅助的、针对焦虑和抑郁的跨诊断ICBT课程。通过完成率、登录次数和交换的电子邮件来评估参与度。治疗后评估治疗满意度。在治疗前、治疗后和3个月时进行抑郁、焦虑和残疾测量。
所有样本都显示出对ICBT的高度参与度和治疗满意度。IC员工在治疗后有显著改善（抑郁d = 0.77；焦虑d = 1.13；残疾d = 0.91），3个月时结果保持稳定。IC计划成员在治疗前的残疾程度明显高于其他样本，治疗后有显著的中等效果（抑郁d = 0.58；焦虑d = 0.54；残疾d = 0.60），但3个月时没有保持改善。两个IC样本治疗后的效应量均显著小于未报告有保险福利的PF样本（抑郁d = 1.14，焦虑d = 1.30）和报告有短期残疾福利的PF样本（抑郁d = 0.95，焦虑d = 1.07）。IC员工和PF样本在残疾方面的效应量没有差异。然而，与没有残疾福利的PF样本（d = 0.90）和领取短期残疾福利的样本（d = 0.94）相比，IC计划成员在残疾方面的效应量明显较小（d = 0.60）。
许多由保险公司转介并资助的客户参与了ICBT，并认为其可接受且有效。然而，在治疗前残疾程度非常高的人群中，结果未能维持。IC组样本量小是一个局限性。已描述了与保险公司资助的ICBT相关的研究方向。
