Claudia Buntrock

BACKGROUND Major depressive disorder (MDD) is a leading contributor to the global burden of disease, associated with substantial impairment in daily functioning and reduced quality of life for the individual and considerable societal costs. Farmers constitute a particularly vulnerable population, facing an elevated depression risk due to occupational, financial, and social stressors, and simultaneously encountering considerable barriers to mental health care. Personalized telephone coaching offers a promising solution for indicative prevention in this group. However, despite the evidence on its clinical effectiveness, the cost-effectiveness and cost-utility of telephone coaching for preventing MDD remain insufficiently examined. OBJECTIVE This economic evaluation aimed to evaluate the cost-effectiveness and cost-utility of a personalized telephone coaching (IG) provided by psychologists compared to treatment-as-usual plus informational material (TAU+) in farmers from a societal and social insurance perspective within a time horizon of 18 months. METHODS An economic evaluation was performed alongside a pragmatic randomized controlled trial (RCT). Health service use, patient and family expenses, and productivity costs were assessed with the adapted German version of the self-report questionnaire TiC-P (Trimbos Institute and Institute of Medical Technology Questionnaire for Costs Associated with Psychiatric Illness). Outcomes were measured in terms of depression symptom-free status (Quick Inventory of Depressive Symptomology – Self-Report (QIDS-SR16)<6) and quality-adjusted life years (QALYs; Assessment of Quality of Life (AQoL-8D)). All assessments were conducted web-based. A cost-effectiveness (CEA) and cost-utility analysis (CUA) were performed from the societal and social insurance perspective. Analyses followed the intention-to-treat principle with multiple imputation. Uncertainty around incremental cost-effectiveness ratio (ICER) estimates was characterized using bootstrapped seemingly unrelated regression equations (2,500 simulations). Sensitivity analyses assessed the robustness of the findings. RESULTS In total, 314 participants were included in the RCT. From a societal perspective, the IG produced a greater number of participants achieving depression symptom-free status (ΔE=0.11, 95%CI –0.01 to 0.23) compared to TAU+ at higher costs (ΔC=€663, 95%CI 2820 to 4052; €1=US $1.12 as of 2019). The probability of the IG being cost-effective was 37% at a willingness-to-pay (WTP) threshold of €0 per depression symptom-free status and QALY gained, rising to 63% when applying a societal WTP of €20,000 per QALY gained (38% from a social insurance perspective). Analyses conducted from the social insurance perspective, as well as sensitivity analyses, indicated the dominance of TAU+ over the IG, with intervention costs as the primary cost driver. CONCLUSIONS Findings suggest that MDD prevention via personalized telephone coaching yield larger effects, albeit accompanied by higher costs from both a societal and social insurance perspective within the observed time horizon. These results inform evidence-based decision-making on cost-effective MDD prevention in occupational groups, and highlight the need for comparative trials with alternative approaches. CLINICALTRIAL German Clinical Trial Registration: DRKS00015655. Registered on October 2, 2018. INTERNATIONAL REGISTERED REPORT RR2-doi:10.3389/fpsyt.2020.00125

Background: Video-based psychotherapy (VBT) is increasingly used to expand access to mental health care. Review studies generally report symptom outcomes similar to those achieved with face-to-face (F2F) psychotherapy. However, these studies often analyze VBT alongside other remote modalities, and it remains unclear what portion of the effects can be attributed to the video-based setting itself. Objective: The objective of this systematic review is to compare VBT and F2F psychotherapy in terms of symptom reduction, using strict methodological inclusion criteria, to maximize comparability between the delivery formats while also considering therapy duration. Methods: We searched bibliographic databases (MEDLINE via PubMed, PsycINFO, and Embase) from inception to May 20, 2025, supplemented by reference checking. The search was updated on March 10, 2026. We conducted a systematic review of randomized controlled trials (RCTs) comparing synchronous VBT with F2F psychotherapy in adults and reporting symptom severity. Trials had to meet a minimum treatment dose (≥500 min) and limited hybrid exposure (≤1/3 of sessions delivered F2F). Interventions had to be delivered by health professionals. We excluded interventions delivered solely via telephone or asynchronous platforms, blended formats, or unstructured counseling or group settings. Risk of bias was assessed following Metapsy (RoB2) guidelines, and certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Standardized mean differences (Hedges g ) of posttreatment symptom severity were synthesized using a 3-level correlated and hierarchical effects (CHE) random-effects model to account for dependent outcomes. Results: Out of 11,386 identified records, 87 articles underwent full-text review; 12 RCTs (465/900, 51.7% female; mean age 40.21, SD 14.52 y) met the inclusion criteria. Diagnoses included posttraumatic stress disorder, depression, obsessive-compulsive disorder, bulimia nervosa, generalized anxiety disorder, and somatoform pain. Across 41 effect sizes, no significant differences in symptom reduction emerged between VBT and F2F psychotherapy (Hedges g=–0.09, 95% CI –0.52 to 0.33; SE=0.19; P >.99). Between-study heterogeneity was substantial; the 95% prediction interval was −1.65 to 1.46. No moderating effects were detected. The Akaike information criterion favored the 3-level model over conventional approaches. Conclusions: The evidence base was limited in size and scope (predominantly Western settings, posttraumatic stress disorder diagnoses, and cognitive behavioral interventions). Study limitations, heterogeneity, and few noninferiority trials reduced the certainty of the evidence. This review is innovative in isolating synchronous VBT from other remote delivery formats to understand the specific impact of the setting. Unlike previous reviews, this one provides a more specific estimate of the effects of the delivery setting. This is achieved by isolating synchronous video delivery, applying dose/setting restrictions, and focusing on RCTs. Results refine the current evidence base and support offering VBT as a pragmatic delivery option to extend access to mental health care. Adequately powered noninferiority trials across diverse diagnoses, cultures, and longer-term treatments are needed.

Introduction: Social functioning is a key component of recovery in depression, yet most research on first-line treatments focuses on symptom reduction, and comparative evidence on social functioning is limited. We aimed to evaluate the comparative effects of psychotherapy, antidepressant medication, and their combination on social functioning in adults with major depression. Methods: We conducted a systematic review and network meta-analysis of randomised controlled trials up to May 1, 2025. Eligible trials compared psychotherapy, antidepressant medication, combined treatment, and control conditions (placebo, care as usual, waitlist, or no/minimal treatment) in adults with major depression. Effects were calculated as standardised mean differences (SMD) in social functioning instruments (e.g., Sheehan Disability Scale) at post-treatment (mean 12 weeks) and follow-up (mean 32 weeks). Random-effects models were used. We assessed risk of bias and conducted sensitivity analyses. Certainty of evidence was evaluated using CINeMA. Results: Of 490 identified trials, 94 (19%; 23,874 participants) reported social functioning and were included. All active treatments outperformed control conditions. Effects varied substantially by control condition type, with waitlist comparisons yielding the largest estimates and comparisons against placebo or care as usual yielding more conservative effects. Combined psychotherapy and pharmacotherapy showed the largest effects versus placebo at post-treatment (SMD 0.75, 95% CI 0.57–0.94) and follow-up (1.08, 0.62–1.54). Psychotherapy and pharmacotherapy did not differ at post-treatment (SMD 0.10, 95% CI −0.05 to 0.25) or follow-up (0.27, 95% CI 0.00–0.54). Certainty of the evidence ranged from moderate to low. Conclusion: First-line depression treatments support not only symptom reduction but also meaningful participation in daily life. However, only one fifth of trials assessed this outcome, highlighting the need to better integrate patient-valued outcomes into future trials.

Introduction: To deliver evidence-based care, medical professionals must be able to critically appraise scientific literature, a skill often underemphasized in traditional medical education. Methods: Supported by the teaching commission of the Medical Faculty of Otto-von-Guericke-University Magdeburg, a novel didactic approach was developed, integrating elements of a Journal Club (JC) with e-learning modules, supervised by a mentor. This approach aims to deepen and apply scientific skills acquired in earlier stages of medical education. Final-year medical students independently select, critically evaluate, and present a scientific paper in a JC that is related to a specific patient. Simultaneously, they are required to complete six online modules (including an orientation module) covering the topics evidence-based clinical practice, literature search, Critical Appraisal Skills Program, basic statistical analysis, and effective presentation skills. Results: In the pilot phase, 25 students and five mentors participated, with 20 students and four mentors completing the evaluation. Students rated the teaching project as relevant (mean 2.4, scale 1 - 4) but expressed mixed views on its suitability for final year (mean 2.5). Self-assessment scores improved across all five learning outcomes, with notable increases in students’ confidence to evaluate clinical relevance and study strengths/weaknesses. Digital modules were rated as comprehensible (scores 1.5 - 2.0) and useful for JC preparation (scores 2.1 - 2.6). The overall teaching project received a mean rating of 2.8 (scale 1 - 6), with 58% (n = 19) of students recommending the course. Mentors unanimously rated the project as highly beneficial (100% recommendation rate). Conclusion: The evaluation of the pilot phase indicates that this teaching project has the potential to significantly enhance students’ ability to critically engage with scientific literature. Ongoing refinement based on feedback and planned implementation across all departments aim to promote sustainable scientific literacy in clinical training.

Men and women differ in the manifestation of depression. At the same time, there is a lack of gender-sensitive depression questionnaires in Germany. This study investigated the Gender-specific binary depression screening version (GIDS-15) in a further validation step. In a two-armed, pragmatic single-blind randomised controlled clinical trial, we first investigated the psychometric properties and the sensitivity to change in the GIDS-15 in a sample with subclinical depression (N = 203). In addition, we then analysed sex differences between the intervention and waiting control group over time. We were able to demonstrate adequate to acceptable internal consistency as well as convergent construct validity of the GIDS-15. Additionally, we were able to demonstrate the sensitivity to change in the GIDS-15. Using a linear mixed model, we calculated a three-way interaction between intervention group, sex, and time (p = 0.017). We found an increase in the intervention effect for men over time. Conclusions: The GIDS-15 proves to be a solid and practical screening tool for the gender-sensitive assessment of depression in Germany. It can be used for progression and intervention diagnostics, although the intervention effect that was found can only be interpreted to a limited extent due to significant sample size differences between men and women. Limitations of our study and practical implications are discussed.