Computerised self help for depression in primary care

In guided self help, patients are supported in using self help materials in the form of pamphlets, booklets, or (increasingly) internet based materials. An expanding evidence base1 has prompted national and international guidelines to recommend guided self help for patients presenting in primary care with symptoms of mild to moderate depression.2 3 For patients benefits include ease of access and lack of stigma; for health systems it enables wider reach at lower cost than face to face psychological interventions.

A linked paper by Gilbody and colleagues (doi:10.1136/bmj.h5627), however, casts doubt on this recommendation (REEACT study).4 In a multicentre randomised controlled trial, they tested one free and one commercial computerised cognitive behavioural therapy (cCBT), with weekly telephone support from a technician, against usual GP care for primary care patients with depression symptoms. Four months later they found no difference in outcome between the three groups. There were some benefits from the free cCBT at 12 months, but these were not sustained a year later.

The authors noted …