3rd Jun 2016 Marco Cavallo

Demographic and clinical predictors of compliance to the cCBT treatment: Which factors help people to treat themselves?

Scientific literature has devoted a great amount of attention to the demographic and clinical variables associated to the compliance of patients to psychological and psychotherapeutic treatments. However, to date very little is known about which factors support patients’ adherence to computerized cognitive-behavioural treatments, like the ones used in the MasterMind pilot. In this contribution to the blog, we would like to start the discussion with all Consortium colleagues and readers about this relevant issue, by providing the demographic and clinical characteristics of the small sample of patients (N=23) who have completed the treatment in our Unit (Azienda Sanitaria Locale Torino 3) so far.  Most of these patients  were included in the cCBT treatment with the additional monitoring via videoconference (18/23), and they underwent a clinical and satisfaction assessment both at the beginning and at the end of treatment.

Twenty-three (14 females – 9 males) out of 120 enrolled patients had already completed the cCBT. Fifteen were older adults (8 f. – 7 m.), five adults (4 f. – 1 m.), and three young adults (2 f. – 1 m.). Eleven were employed (7 f. – 4 m.), 11 unemployed (7 f. – 4 m.), one unknown. About their level of education: 15 had higher (9 f. – 6 m.), seven secondary (4 f. – 3 m.), and one primary (f.) level of formal education. As regards the level of severity: two were severe (f.), 16 moderate (10 f. – 6 m.), 5 mild (f.). Eighteen underwent additional ccVC to cCBT (10 f. – 8 m.).

One-hundred patients had been recruited by 20 GPs,  five of whom enrolled  one patient each, 8 GPs from 2 to 5, 4 GPs from 6 to 9, and 3 GPs from 10 to 15 patients. The remaining 20 patients were recruited by the psychiatrists and/or psychologists of our unit.

Considering that mild, moderate or severe depression is supposed to affect (as  long life incidence) 10% of the population, that the yearly incidence is around 5 % of the population, and that the catchment area of ASL TO3 includes 590,000 inhabitants (c. 440,000 over 18 years old), we might have expected to reach easily the proposed number of 300 patients. The possibility to achieve this purpose was supported by the fact that we could reach twice 90% of the GPs (c. 500) for the presentation of  the MM pilot project and that around 40 GPs attended ad hoc courses on depression and on the use of MM dedicated tools.  Data  shows that collaboration with GPs continues to be sporadic and usually they do not feel the necessity to collaborate with specialists (psychiatrists and/or psychologists). This consideration becomes more effective considering that out of the 20 GPs who enrolled patients, only 7 enrolled from 6 to 15 patients (in the Italian National Health System each GP follows from 1,000 to 1,500 inhabitants).

The psychological measure used to screen for the presence of depressive symptoms (PHQ-9) yielded an average score of 11.21 (6.3) at the beginning of the treatment, and an average score of 8.13 (5.4), with lower scores showing better clinical condition. Of course, the present data are still preliminary and  then it is still not possible to conclude about its clinical efficacy or lack thereof, but nevertheless  in our view they can be useful for some first considerations.

The  frequency of patients’ dissatisfaction about the use of the cCBT tool per se is high (10/23 patients) and a moderate satisfaction level has been declared by 7 patients. Interestingly, most of the patients said they were encouraged by the additional use of ccVC,  namely by the possibility to contact the psychologists directly to get supervision of their cCBT treatment.

Due to the small sample size of completers until now, it is not possible yet to build up complex statistical models (such as logistic regression models) to investigate the unique contribution of demographic (e.g., age, gender, level of formal education, employment status) and clinical (e.g., severity of depression, additional presence of ccVC monitoring) factors to the compliance to the cCBT treatment. However, we think that some of them could play a role in fostering (or reducing) patients’ motivation to follow cCBT treatment regularly and effectively.

These are preliminary considerations on the possible demographic and clinical predictors of compliance to the cCBT treatment: we are very curious about partners’ experience and ideas, and it would be great for us to know how are things going in other units, compliance-wise!

Pier Maria Furlan, Enrico Zanalda, Marco Cavallo, Ylenia Sacco, Arianna Signorino, Maria Luisa Perucchini (ASL TO3)

Silvia Andernello, Maria Grazia Guala (CSI Piemonte)


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