Effects of Remotely Delivered and Web-Based Interventions on Depression Severity During the COVID-19 Pandemic: 3-Arm Randomized Controlled Trial

BACKGROUND: The COVID‐19 pandemic highlighted a critical need for effective population mental health approaches to target the most prevalent disorders (eg, depression) during periods of elevated community distress. The effectiveness of remotely delivered and web‐based interventions should be investigated to identify and innovate high‐quality models for population mental health service delivery. OBJECTIVE: The primary objective investigated the effectiveness of adding Mindfulness‐Based Cognitive Therapy for Resilience (MBCT‐R)‐a live, online, synchronous, remotely delivered, group‐based intervention‐to Cambridge Health Alliance MindWell (CHA‐MW), a web‐based population health screening and stratified support program, compared with CHA‐MW alone, on depression symptom severity. The secondary objective evaluated adding internet Cognitive Behavioral Therapy (iCBT)‐an asynchronous, web‐based, individual, digital intervention‐to CHA‐MW, compared with CHA‐MW alone. METHODS: Participants (N=97) were randomized in a 2:2:1 ratio to receive MBCT‐R+CHA‐MW (n=37), iCBT+CHA‐MW (n=41), or CHA‐MW alone (n=19) in a 3‐arm randomized clinical trial, from May 2021 to September 2022 in an urban public safety net hospital outpatient setting. CHA‐MW served as a low‐intensity control condition. For the MBCT‐R+CHA‐MW arm, MBCT‐R was an 8‐session program mildly adapted from MBCT to address COVID‐19‐related risks for depression. For the iCBT+CHA‐MW arm, iCBT was a 6‐session curriculum added to CHA‐MW. All study procedures, including regular mental health symptom screenings, were conducted remotely or via a web‐based platform. The primary outcome was change in depression symptom severity during the 24‐week study period using an intention‐to‐treat approach that used generalized linear mixed‐effects models to evaluate the comparative effectiveness of MBCT‐R+CHA‐MW vs CHA‐MW over time. A secondary analysis compared iCBT+CHA‐MW vs CHA‐MW on depression severity. Completer analyses were conducted (per‐protocol 6+ sessions). The secondary outcome was mental health visit utilization frequency during the study period. CONCLUSIONS: MBCT‐R+CHA‐MW, iCBT+CHA‐MW, and CHA‐MW were each effective in treating depression, without any intervention demonstrating superiority in intention‐to‐treat analyses. CHA‐MW was as efficacious during the COVID‐19 pandemic as more resource‐intensive interventions that demanded greater time and effort from participants. Low completion rates for MBCT‐R and iCBT during the COVID‐19 pandemic may have contributed to these results. RESULTS: Both MBCT‐R+CHA‐MW (mean difference ‐14.1, 95% CI ‐21.0 to ‐7.2) and CHA‐MW (mean difference ‐15.2, 95% CI ‐21.8 to ‐8.6) had significant reductions in depression symptom severity, with no statistically significant between‐group differences. iCBT+CHA‐MW (mean difference ‐12.7, 95% CI ‐17.4 to ‐8.1) also reduced depression symptoms but without between‐group differences when compared with CHA‐MW. Intervention completion rates were low (MBCT‐R: 30% and iCBT: 24%), and completers demonstrated significantly greater reductions in depression severity than noncompleters (mean difference ‐8.5, 95% CI ‐16.2 to ‐0.8). Overall mental health clinician visits by group had no statistically significant differences. CHA‐MW had the largest increase in participants with new psychopharmacology treatment visits during the 24‐week study (CHA‐MW +21%, MBCT‐R +10%, and iCBT ‐5%).