Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial.

Sandra Schlicker,Kiona K Weisel,Dirk Lehr,David D Ebert,Harald Baumeister,Stephanie Nobis,Frank J Snoek,Claudia Buntrock,Matthias Berking,Heleen Riper

doi:10.1155/2019/2634094

Abstract

Introduction Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Methods Randomized controlled trial- (RCT-) based data (N = 253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES − D > 40; N = 40). Results Major depressive disorder diagnosis at the baseline (pprf6 = 0.01), higher levels of depression (Beck Depression Inventory II; pprpo = 0.00; pprf6 = 0.00), and lower HbA1c (pprpo = 0.04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (dprpo = 2.17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (dprpo = 0.92; 95% CI: 0.001-1.83), with a between-group effect size of dprpo = 1.05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ2 (2)(N = 40) = 4.44; p < 0.02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (dpr6f = 0.71; 95% CI: 0.19-1.61) but not treatment response. Conclusion Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.

Highlights

Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression
Internet- and mobile-based interventions (IMIs) provide the following: (1) easy accessibility at any time and place; (2) possible anonymity if desired; (3) individuals can work at their own pace and have the opportunity to review materials as often as they want; (4) easy scalability; only a small increase of resources is required for reaching a greater proportion of the eligible population using these interventions; and (5) reaching populations that may not partake in existing traditional onsite interventions [3]
To explore whether the findings of van Bastelaar et al [12] are applicable for our GET.ON M.E.D. study population, we investigated disease-specific severity indicators as the treatment outcome modifier

Summary

Introduction

Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. A common comorbidity is major depressive disorder (MDD), which affects 10 to 20% of adult diabetes patients, resulting in poorer diabetes self-management, poorer general health outcome, higher frequency of secondary diseases, decreased quality of life, and a higher mortality rate. IMIs provide the following: (1) easy accessibility at any time and place; (2) possible anonymity if desired; (3) individuals can work at their own pace and have the opportunity to review materials as often as they want; (4) easy scalability; only a small increase of resources is required for reaching a greater proportion of the eligible population using these interventions; and (5) reaching populations that may not partake in existing traditional onsite interventions [3]

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Results