Comparing Clinical Decision-making of AI Technology to a Multi-professional Care Team in an Electronic Cognitive Behavioural Therapy Program for Depression

Participants (n = 186: n = 31 per e-CBT group * 2 arms) will be recruited at Queen's University from outpatient psychiatry clinics at both Kingston Health Sciences Centre sites (Hotel Dieu Hospital and Kingston General Hospital), as well as Providence Care Hospital in Kingston, Ontario. Additionally, self-referrals and referrals from family doctors, physicians, and clinicians across Ontario will be accepted. After obtaining informed consent from the participant, the participant will be evaluated using the Mini International Psychiatric Assessment (MINI) through a secure video appointment to confirm a diagnosis of Major Depressive Disorder using the DSM-5 by a trained professional on the research team.

All eligible participants will be randomized to receive a treatment plan based on the decision of either the healthcare team (Arm 1) or the Triage Module using an AI algorithm (Arm 2). Participants will be randomly allocated to one of the two arms of the study by a research assistant on the team who will also balance the group based on demographic variables (i.e., sex, gender, age, and income). Participants and therapists in the study will be blinded to which treatment arm the participant belongs to. By the nature of this study, participants and therapists will not be blinded to which treatment intensity the participant will receive since it will be evident whether the participant is receiving a phone/video call in addition to usual e-CBT care or pharmacotherapy. Each participant will be provided with an effective form of treatment (i.e., e-CBT) regardless of which group they will be allocated to. Participants will be informed that there is no incentive for joining the program and that joining or withdrawing at any point will not affect them negatively. It will also be explained to the participants that the program is not a crisis resource and that they will not always have access to their therapists. In the case of an emergency, participants will be directed to proper resources, and this event will be reported to the study's lead psychiatrist (principal investigator). All data will be anonymized and will be analyzed by members of the research team who are not directly involved in the patient's care.

Treatment Arm 1: Healthcare Team Allocation

Allocation of treatment intensity by the multi-professional healthcare team will be based on the following criteria:

1. The severity of MDD symptoms (using DSM-5 criteria).
2. Mental health factors (prior treatments and responses, current and past psychotic/manic episodes, current and past suicidal/homicidal ideation/attempts, family mental health history, past psychiatric history, and hospital admissions).
3. Medical factors (current medical conditions and medications, personal and family medical history).
4. Social factors (support system and living situation, and occupational, social, and personal functional impairment).