Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: a randomized controlled trial.

Major depressive disorder (MDD) is prevalent after TBI, yet there is a lack of evidence regarding effective treatment approaches. We conducted a choice-stratified randomized controlled trial in 100 adults with MDD within 10 years of complicated mild to severe TBI to test the effectiveness of brief cognitive behavioral therapy administered over the telephone (CBT-T, n=40) or in-person (CBT-IP, n=18), compared to usual care (UC, n=42). Participants were recruited from clinical and community settings throughout the United States. The main outcomes were change in depression severity on the clinician-rated 17-item Hamilton Depression Rating Scale (HAMD-17) and the patient-reported Symptom Checklist-20 (SCL-20) over 16 weeks. There was no significant difference between the combined CBT and UC groups over 16 weeks on the HAMD-17 (Treatment effect=1.2, 95% CI: -1.5 to 4.0; P=0.37) and a non-significant trend favoring CBT on the SCL-20 (Treatment effect= 0.28, 95% CI: -0.03 to 0.59; P=0.074). In follow-up comparisons, the CBT-T group had significantly greater improvement on the SCL-20 compared to the UC group (Treatment effect= 0.36, 95% CI: 0.01 to 0.70; P=0.043) and completers of >8 CBT sessions had significantly improved SCL-20 scores compared to the UC group (Treatment effect = 0.43, 95% CI: 0.10 to 0.76; P=0.011). CBT participants reported significantly greater symptom improvement (P=0.010) and greater satisfaction with depression care (P Language: en