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Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression: results from the CALM non-inferiority, randomised trial
O’Neil et al. (2024) conducted the first non-inferiority randomized controlled trial to assess whether lifestyle therapy is equally effective as psychotherapy in improving mental health outcomes and cost-effectiveness when delivered through online videoconferencing. The study used an individually randomized, group treatment design with computer-generated block randomization.182 persons with a Distress Questionnaire-5 (DQ-5) score of ≥8, which indicates depression, were selected from a tertiary mental health facility in remote Victoria, Australia, between May 2021 and April 2022. Participants were randomly assigned to one of two groups: (1) lifestyle therapy (focused on nutrition and physical activity) delivered by a dietitian and exercise physiologist (n = 91) or (2) psychotherapy (Cognitive Behavioral Therapy) delivered by psychologists (n = 91). With a non-inferiority margin of ≤2, the main outcome was the degree of depression as assessed by the Patient Health Questionnaire-9 (PHQ-9) at 8 weeks. A cost-minimization study was conducted to compare overall costs from the viewpoints of the health sector and society at large. Blinded study assistants used Computer-Assisted Telephone Interviews (CATI) to evaluate the results. The sample consisted of 80% women, with an average age of 45 (SD = 13.4) and a mean PHQ-9 score of 10.5 (SD = 5.7). Participants attended an average of 4.2 out of 6 sessions, with complete data available for 132 participants. Over the 8 weeks, depression decreased in both groups. Both groups showed evidence of non-inferiority. The cost of lifestyle treatment was lower, but overall expenses did not change much. Remote-delivered lifestyle therapy was found to be non-inferior to psychotherapy in terms of both clinical outcomes and costs. If these findings are confirmed in a larger trial, this approach could enhance access to mental health care by enabling allied health professionals, with appropriate training and guidelines, to provide effective care at a cost comparable to that of psychologists. [NPID: Lifestyle psychiatry, digital health, psychotherapy, mental health, non-inferiority]
Year: 2024
