Effects of Remotely Delivered and Web-Based Interventions on Depression Severity During the COVID-19 Pandemic: 3-Arm Randomized Controlled Trial.
Zev Schuman-Olivier, Liv Valö, Joseph Rosansky, Gareth Parry, Alexandra Comeau, Fiona Kate Rice, Carl Fulwiler
JMIR Mental Health August 4, 2026 DOI: 10.2196/88388 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 97 |
| Population | Adults in an urban public safety net hospital outpatient setting during the COVID-19 pandemic |
| Interventions | Mindfulness-Based Cognitive Therapy for Resilience (MBCT-R) internet Cognitive Behavioral Therapy (iCBT) Cambridge Health Alliance MindWell (CHA-MW) |
| Duration | 24-week study period; MBCT-R was 8 sessions; iCBT was 6 sessions |
| Topics | Depression Meditation |
| Keywords | Covid-19 pandemic Mindfulness-based cognitive therapy Cognitive behavioral therapy Digital health Population mental health Randomized controlled trial Stratified care Telehealth |
| Key findings | MBCT-R+CHA-MW, iCBT+CHA-MW, and CHA-MW each reduced depression symptom severity over 24 weeks (mean differences -14.1, -12.7, and -15.2, respectively), with no statistically significant between-group differences in intention-to-treat analyses. The authors suggest low completion rates for MBCT-R (30%) and iCBT (24%) may have contributed to the lack of superiority, and note that CHA-MW alone was as efficacious as the more resource-intensive interventions. |
Abstract
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. 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. 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. 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%). 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.
Comparable studies
Other randomized controlled trials on depression, most cited first.
Citations in the library
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