{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:04:12Z","timestamp":1782846252742,"version":"3.54.5"},"reference-count":47,"publisher":"JMIR Publications Inc.","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Ment Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anxiety and depression are leading causes of disability but are often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care. ICBT has been found to be efficacious in research trials and routine care, but there is limited research of ICBT when it is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to examine ICBT engagement, treatment satisfaction, and effectiveness among individuals involved with 2 insurance companies. The 2 samples were benchmarked against published outcomes from a publicly funded (PF) ICBT clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Individuals who were on or recently in receipt of disability benefits and were either insurance company (IC) employees (n=21) or IC plan members (n=19) were referred to ICBT funded by the respective insurance companies. Outcomes were benchmarked against outcomes of ICBT obtained in a PF ICBT clinic, with clients in the clinic divided into those who reported no involvement with insurance companies (n=414) and those who were on short-term disability (n=44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting anxiety and depression. Engagement was assessed using completion rates, log-ins, and emails exchanged. Treatment satisfaction was assessed posttreatment. Depression, anxiety, and disability measures were administered pretreatment, posttreatment, and at 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All samples showed high levels of ICBT engagement and treatment satisfaction. IC employees experienced significant improvement at posttreatment (depression d=0.77; anxiety d=1.13; and disability d=0.91) with outcomes maintained at 3 months. IC plan members, who notably had greater pretreatment disability than the other samples, experienced significant moderate effects at posttreatment (depression d=0.58; anxiety d=0.54; and disability d=0.60), but gains were not maintained at 3 months. Effect sizes at posttreatment in both IC samples were significantly smaller than in the PF sample who reported no insurance benefits (depression d=1.14 and anxiety d=1.30) and the PF sample who reported having short-term disability benefits (depression d=0.95 and anxiety d=1.07). No difference was seen in effect sizes among IC employees and the PF samples on disability. However, IC plan members experienced significantly smaller effects on disability d=0.60) compared with the PF sample with no disability benefits d=0.90) and those on short-term disability benefits d=0.94).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Many clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pretreatment disability. Small sample sizes in the IC groups are a limitation. Directions for research related to ICBT funded by insurance companies have been described.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/16005","type":"journal-article","created":{"date-parts":[[2019,12,15]],"date-time":"2019-12-15T05:46:55Z","timestamp":1576388815000},"page":"e16005","source":"Crossref","is-referenced-by-count":6,"title":["An Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Clients Referred and Funded by Insurance Companies Compared With Those Who Are Publicly Funded: Longitudinal Observational Study"],"prefix":"10.2196","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7092-9056","authenticated-orcid":false,"given":"Heather D","family":"Hadjistavropoulos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8686-2717","authenticated-orcid":false,"given":"Vanessa","family":"Peynenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5036-9055","authenticated-orcid":false,"given":"Swati","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2647-0070","authenticated-orcid":false,"given":"Kelly","family":"Adlam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1638-696X","authenticated-orcid":false,"given":"Marcie","family":"Nugent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4217-3236","authenticated-orcid":false,"given":"Kirsten M","family":"Gullickson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-729X","authenticated-orcid":false,"given":"Nickolai","family":"Titov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9324-3092","authenticated-orcid":false,"given":"Blake","family":"Dear","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2020,2,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.6.593"},{"key":"ref2","unstructured":"World Health Organization20191242019-12-23Depression https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/depression"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31678-6"},{"key":"ref4","unstructured":"Mental Health Commission of Canada2019-12-23Workplace https:\/\/www.mentalhealthcommission.ca\/English\/what-we-do\/workplace"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291710002291"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2018.07.006"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-021815-093006"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2017.1401115"},{"key":"ref9","unstructured":"Health Quality Ontario2019022019-12-23Internet-Delivered Cognitive Behavioural Therapy for Major Depression and Anxiety Disorders: Health Quality Ontario Recommendation https:\/\/www.hqontario.ca\/Portals\/0\/documents\/evidence\/reports\/recommendation-internet-delivered-cognitive-behavioural-therapy-en.pdf"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.61.4.271"},{"key":"ref11","unstructured":"Government of Canada2019-12-23Canada's Health Care System https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-health-care-system.html"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2016.05.006"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291718000065"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20346"},{"key":"ref15","unstructured":"World Health Organization201208272019-12-23Risks to Mental Health: An Overview of Vulnerabilities and Risk Factors https:\/\/www.who.int\/mental_health\/mhgap\/risks_to_mental_health_EN_27_08_12.pdf"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdx168"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.00162"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-017-9714-1"},{"key":"ref19","author":"Harnois, G","year":"2002","journal-title":"Mental Health and Work: Impact, Issues and Good Practices"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-017-9730-1"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0067162"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-014-9513-x"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-014-9506-9"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2013.4023"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2007.06.013"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7251-x"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-018-9918-5"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-018-9921-x"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1037\/a0036915"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201400477"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.110829"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"ref34","author":"Sheehan, D","year":"1983","journal-title":"The Anxiety Disease: New Hope for the Millions Who Suffer from Anxiety"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2016.03.005"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-015-0022-1"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.01.014"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181caeb90"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.2196\/10200"},{"key":"ref41","author":"Cohen, J","year":"1969","journal-title":"Statistical Power Analysis for the Behavioral Sciences"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1002\/da.22249"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31815e3a10"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.2196\/10204"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2016.09.003"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.2196\/mental.9769"}],"container-title":["JMIR Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mental.jmir.org\/2020\/2\/e16005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:09:24Z","timestamp":1782842964000},"score":1,"resource":{"primary":{"URL":"https:\/\/mental.jmir.org\/2020\/2\/e16005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,4]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2196\/16005","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.16005","asserted-by":"object"}]},"ISSN":["2368-7959"],"issn-type":[{"value":"2368-7959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,4]]}}}