Abstract
BackgroundWe recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression.ObjectiveThe aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up.MethodsOverall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3).ResultsAt follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group.ConclusionsWeb-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists’ concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed.Trial RegistrationClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.
Highlights
Benefit and Effectiveness of Web-Based InterventionsDepression has been recognized as one of the leading health problems with a 12-month prevalence of 6.9% [1] and an even higher prevalence of depression and depressive symptoms in outpatients of different clinical specialties (27%) [2]
Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up
Sensitivity analyses have shown that general efficacy (g=0.36) is lower (g=0.17), when publication-bias is considered, an active control group is used as a comparative condition (g=0.12 vs g=0.53), guidance is missing (g=0.23 vs g=0.75), or adherence is low (g=0.22 vs g=0.64); on the other hand efficacy is higher in some countries, such as Australia (g=0.78) than in others
Summary
Benefit and Effectiveness of Web-Based InterventionsDepression has been recognized as one of the leading health problems with a 12-month prevalence of 6.9% [1] and an even higher prevalence of depression and depressive symptoms in outpatients of different clinical specialties (27%) [2]. Deprexis is an interactive Web-based self-help program [9] with proven effectiveness in several randomized controlled studies (RCTs). In a recent meta-analysis of self-guided Web-based interventions for the treatment of depressive symptoms [10], 13 trials of which 5 were Deprexis trials have been combined, and the overall effect was g=0.31. Compared with the meta-analysis of Karyotaki [10] with heterogenous internet-based cognitive behavioral therapy interventions, a recent meta-analysis based on 8 studies with Deprexis reported a slightly higher posttreatment between-group effect size for the improvement of depressive symptoms of g=0.54 (95% CI 0.39-0.69) [11]. We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression
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