This is a somewhat uneven account of a study of the use of a web-based therapy program in the reduction of suicidal thoughts in medical interns. While some elements of the story are solid, it is incomplete in some important aspects. The reader is provided with insufficient information on key components of the study design, in the timing of the collection of data presented, and on alternative approaches. While the comments of Dr. Dalechek are useful for context, they do not replace the comments of an unaffiliated expert in the field.
Just about one physician commits suicide daily in the United States and the risk is highest during the early days and months of training. The use of a simple and generally available web-based therapy for medical interns is an intriguing idea that as the primary author notes needs to be validated in a larger study.
The story says the study involved a free online program developed in Australia. Knowing that it is free may be incentive enough for some individual doctors or their hospitals to look into it — so this is useful information.
The story has some useful information on the benefits of the online therapy. We are told that, “Overall, 12 percent of interns who got online therapy said they had thought about suicide during the year, versus 21 percent of the interns who received four weekly emails with information on depression and where to seek help” and “that interns who got the sessions were 60 percent less likely to have those thoughts than the other group.” However there is no mention of timeframe or the durability of the benefit over time. The suicidal ideation actually increased in both groups from baseline. (Figure 3 in the manuscript highlights the data collection) The figures provided reflect the numbers of interns who had suicidal ideation at least once during the one year data collection. It is also important to point out that 48% of the medical interns participating had a baseline history of depression. And while suicidal thoughts might have been prevented, we don’t know if the intervention would have any effect on actual suicide attempts or success rates.
It is hard to imagine harms associated with this approach so we will rate it as not applicable.
On the plus side we are told that 200 medical residents participated in the study. Unfortunately we aren’t told how many in the web based therapy actually participated and completed the sessions. This type of study obviously cannot be blinded to the participants but could be to the data collectors but no information is provided in this regard. The actual participation of both groups was far less than 100%. Only 51% of those assigned to the online therapy actually completed all four sessions.
The story provides some useful insight into the realities of medical training and in the risk of suicide especially in the early internship months.There does not seem to be any evidence of disease mongering.
The story provides comments from a psychiatry resident not affiliated with the study who offers an important view from the inside.With that being said, we wish the story had included the views of an expert in the field, commenting specifically on the intervention that’s the basis for the story.
The study in question compared access to a web based therapy plan to emailed reminders of available resources. We would like to have seen some comment on the relative value of traditional individualized “talk” therapy to compare to the web based program.
The story notes that the study, “.. used a free online program developed at the National Institute for Mental Health Research at the Australian National University in Canberra.” but provides no additional information about general availability outside of the study.
The story should have mentioned the name of the online program that was used for the study in the case that any current residents may want to try it for themselves, or perhaps family members or friends of current residents may want to suggest the program if they come across the story.
Web based therapy for depression is not new or novel. Its use in general population is well described in the literature. What is perhaps new is the use of a web based protocol in this high risk group.
The story does not appear to be based on a news release.