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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Jul 5, 2019
Open Peer Review Period: Jul 9, 2019 - Aug 30, 2019
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A randomized controlled trial of coach-facilitated web-based therapy compared to information about web-based resources, in patients referred to secondary mental health care for depression

  • Sarah MacLean; 
  • Daniel Corsi; 
  • Sadie Litchfield; 
  • Julia Kucharski; 
  • Kira Genise; 
  • Zeynep Selaman; 
  • Valerie Testa; 
  • Simon Hatcher; 



Depression is a common mental disorder with a high social burden and significant impacts on suicidality and quality of life. Treatment is often limited to drug therapies due to long waiting lists to see psychological therapists face-to-face, despite recommendations by the National Institute for Health and Care Excellence (NICE) about the importance of non-drug therapies.


The primary objective of this randomized controlled trial (RCT) was to ask: in patients on a waitlist to receive secondary mental health care services for depression, how effective is coach-guided web-based therapy compared to receiving information about web-based resources at reducing depression symptoms after 12 weeks?


We conducted an RCT with two parallel arms. Participants were recruited face-to-face from the Royal Ottawa Mental Health Centre (ROMHC), a secondary mental health care facility in Ottawa, Canada. Participants randomized to the control group received usual care plus a leaflet on web-based depression resources. Those assigned to the intervention group received 12 weeks of The Journal, a coach-facilitated web-based therapy program. The primary outcome measure in this trial was changes in depression scores, as measured by the Patient-Health Questionnaire (PHQ-9). A process evaluation, which included interviews with study participants, was also conducted.


A total of 95 participants were enrolled in the trial (intervention=47; control=48). The mean change in PHQ-9 scores from baseline to week 12 was -3.6 (SD=6.6) in the intervention group compared to -3.1 (SD=6.2) in the control group which was not a statistically significant difference (t = -0.37, df = 91, P=0.72; 95% CI -3.1 to 2.2). At 12 weeks participants in the intervention group reported higher health-related quality of life (mean EQ-5D-VAS 66.8 SD 18.0) compared to the control group (mean EQ-5D VAS=55.9, SD=19.2) (t=-2.73, df=84, P=0.01). There were no statistically significant differences between the two groups in health service use following their initial consultation with a psychiatrist. The process evaluation showed that participants in the intervention group completed a mean number of 5.0 (SD=2.3) lessons in The Journal and 8.8 (SD=3.1) sessions with the coach. The 29 participants in the intervention group (62% of the total) who completed the full “dose” of the intervention, by finishing six or more Journal sessions, were significantly more likely to have a clinically important reduction in depressive symptoms at 12 weeks compared to the control group (X2=6.33, df=1, P=0.01, Ф=0.37). Participants who completed the qualitative interviews reported that the role played by the coach was a major factor in adherence to The Journal.


The results of this study demonstrate that the use of guided e-therapy for the treatment of depression is not more effective than an information-only waitlist control. However, it showed that coach-guided e-therapy has the potential to increase adherence and engagement with online depression treatment protocols. Further research is needed on what makes an e-therapy coach effective. Clinical Trial: NCT02423733


Please cite as:

MacLean S, Corsi D, Litchfield S, Kucharski J, Genise K, Selaman Z, Testa V, Hatcher S

A randomized controlled trial of coach-facilitated web-based therapy compared to information about web-based resources, in patients referred to secondary mental health care for depression

JMIR Preprints. 05/07/2019:15001

DOI: 10.2196/preprints.15001


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