Background: Mental health treatment rates are increasing but the burden of disease has not reduced. Tools to support efficient resource distribution are required. Aim: To investigate whether a person-centred e-health platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care. Design and setting: Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia (April 2016 to February 2019). 1868 participants (aged 18 – 65; current depressive symptoms; Internet access; no recent change to antidepressant; no current antipsychotic medication; no current psychological therapy) were randomised (1:1) via computer-generated allocation to intervention or usual care. Methods: The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, there were no substantive protocol deviations. Primary outcome: Depressive symptom severity (PHQ-9) at 3 months. Results: In ITT analysis, the estimated between-arm difference in mean PHQ-9 scores at 3 months was -0.88 (95% CI: -1.45 to -0.31), favouring the intervention, and -0.59 at 12 months (95% CI: -1.18 to 0.01); standardised effect sizes of -0.16 (95% CI: -0.26 to -0.05) and -0.1 (-0.21 to 0.0002), respectively. No serious adverse events were reported. Conclusions: Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.
- Received August 20, 2020.
- Accepted December 11, 2020.
- Copyright © 2020, The Authors
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