The complex association of barriers and interest in internet-delivered cognitive behavior therapy for depression and anxiety: informing e-health policies through exploratory path analysis

J Ment Health. 2022 Dec;31(6):738-747. doi: 10.1080/09638237.2020.1793125. Epub 2020 Jul 25.


Background: Internet-delivered cognitive behavioral therapy (ICBT) provides critical remote access to mental health care to at-risk populations. However, to our knowledge, no investigation has been conducted to understand complex pathways through which barriers to care (i.e. structural, attitudinal and technological) correlate with patient interest in ICBT.

Aim: The objective of this study is to develop and test a pathway analysis framework using structural equation modeling to understand direct and mediating associations of barriers to care with interest in ICBT.

Methods: This cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n = 200) in Saskatchewan, Canada. An online survey assessed interest in ICBT, barriers to ICBT, demographics, and depression and anxiety symptoms. Utilizing structural equation modeling, a path analysis framework was developed.

Results: Path analysis results showed how associations between complex barriers and demographic variables correlate with interest in ICBT. For instance, the negative association of perceived financial concerns and life chaos on interest in ICBT was mediated by perceived access to care.

Conclusion: The findings identify specific barriers that could be addressed through targeted population health interventions to improve uptake of ICBT.

Keywords: ICBT; anxiety; behavior therapy; depression; digital health; e-Health; health policy.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Anxiety / psychology
  • Cognitive Behavioral Therapy* / methods
  • Cross-Sectional Studies
  • Depression* / therapy
  • Humans
  • Internet
  • Treatment Outcome