Feasibility, Efficacy, and Perceptions of an Online Writing Intervention in Patients With Major Depressive Disorder: A Multi-methods Study

I. Introduction and Background

In a 2012 Statistics Canada Survey, 1.6 million Canadians reported that their needs for mental health services were unmet. In Ontario, almost 60% of mental health concerns are related to Major Depressive Disorder (MDD), representing an estimated excess of 210 million dollars in healthcare costs. Psychotherapy is an effective and enduring option for treating depression, but in Canada, its availability is limited. Increasing the number of psychotherapists does not seem to be an adequate solution to this issue; despite an increase in psychotherapy provision in the past decade, many Canadians are still in need of psychotherapy.

One solution is to develop innovative therapies that can be delivered reliably at low costs to large populations, for example, using the internet. Expressive writing (EW) is a simple intervention involving a series of journaling tasks where individuals write their deepest thoughts and feelings about a negative issue or problem. There is a large literature examining the various physical and psychological benefits associated with EW among different populations. EW appears to be a promising intervention for MDD. In one study of clinically depressed patients, EW completed in person for 20 minutes over three consecutive days resulted in less depressive symptoms relative to control writing, and this effect persisted after one month. Importantly, EW does not require manuals or highly trained clinicians, making it cost-effective and amenable to being administered remotely. Preliminary studies of its online administration with depressed individuals have produced encouraging findings.

II. Rationale and Study Objectives This study determines whether it is feasible to administer EW online to patients with MDD, and whether patients find it useful.

Feasibility concerns. Although the open-ended nature of EW makes it easy for patients to complete remotely (i.e., without the guidance or presence of a clinician), it presents a risk of drop-out particularly in severely depressed patients, due to a lack of motivation and other factors. The investigators assess the feasibility of administering EW remotely (i.e., online or by mail) to participants seeking treatment at CAMH for Major Depression. They also examine participants' perceptions of EW (i.e., its potential benefits and limitations), as well as their motivation and engagement with the intervention.