Supported Online Self-Help for Veterans With Depression in Primary Care

Background: VA's Primary Care‐Mental Health Integration (PCMHI) is rooted inevidence‐based collaborative care models, where care managers, mental health specialists,and primary care providers jointly treat depression in primary care. While PCMHI enabledspecialists to support medication treatment in primary care, access to psychotherapy isnot timely and sufficient. Alternative therapy modalities are needed. Peer‐supported cCBTfor depression has been shown to be effective but is not yet widely used within VA.Significance/Impact: Depression is disabling and affects one in five Veterans.Psychotherapy is preferred by Veterans, but fraught with multilevel barriers (e.g., staffavailability, patient travel to clinic, limited clinic hours). Without enhancing existingPCMHI models to enable better primary care patient access to effective psychotherapies,Veteran engagement in depression treatment is unlikely to improve.Innovation: This study aims to close the gap in psychotherapy access for VA primary carepatients with depression by adapting PCMHI collaborative care models to improve uptake ofpeer‐supported computerized cognitive behavioral therapy (cCBT). cCBT is accessible 24/7via the internet and has effectively treated depression in more than 30 trials. With peerspecialist support, it is comparable to face‐to‐face psychotherapy. Peer supportspecialists and PCMHI teams can facilitate Veteran uptake of cCBT, using anevidence‐based collaborative care model to provide the follow‐up care management andmental health specialist back‐up that characterizes the most effective cCBT trials.Specific Aims/Methodology: This study involves 400 recent military service members andVeterans in VA Greater Los Angeles and San Diego. VA providers help service membersundergoing discharge at military treatment facilities transition to the VA for care. Onceat the VA, providers screen patients every year for depression. This randomized clinicaltrial will study the implementation and effectiveness of online therapy for depression.First, to help providers deliver and monitor online treatment, we will use three testedstrategies for implementation: facilitators/coaches, quality improvement, and datamonitoring/dashboards. Second, we will randomly assign patients who are newly diagnosedwith depression to receive either: 1) online therapy supported by Veterans peers and VAPCMHI clinical teams (SOS‐D intervention), or 2) online therapy supported by VA PCMHIclinical teams alone (enhanced usual care). Our research team will measure and comparedepressive symptoms at the study start then at 3 months and 6 months across both groups.We will measure how much online therapy is used by each group. Third, through interviewswe will compare the experiences of women Veterans and patients with TBI using onlinetherapy to men Veterans and those without TBI.Next Steps/Implementation: This research will demonstrate how online depression treatmentcan be given to military service members, Veterans, and civilians on a larger scale.Bringing Veteran peers onto VA clinical teams can enhance use of online therapy fordepression and support Veteran recovery. Ensuring depression treatment is availableimmediately when needs are identified is important in preventing suicide.