Internet-based guided self-help for glioma patients with depressive symptoms: design of a randomized controlled trial

Florien W Boele,Jan J Heimans,Jaap C Reijneveld,Pim Cuijpers,Irma M Verdonck-De Leeuw,Martin Klein

doi:10.1186/1471-2377-14-81

Abstract

BackgroundAmong glioma patients, depression is estimated to be more prevalent than in both the general population and the cancer patient population. This can have negative consequences for both patients and their primary informal caregivers (e.g., a spouse, family member or close friend). At present, there is no evidence from randomized controlled trials for the effectiveness of psychological treatment for depression in glioma patients. Furthermore, the possibility of delivering mental health care through the internet has not yet been explored in this population. Therefore, a randomized controlled trial is warranted to evaluate the effects of an internet-based, guided self-help intervention for depressive symptoms in glioma patients.Methods/designThe intervention is based on problem-solving therapy. An existing 5-week course is adapted for use by adult glioma patients with mild to moderate depressive symptoms (Center for Epidemiology Studies Depression Scale score ≥12). Sample size calculations yield 126 glioma patients to be included, who are randomly assigned to either the intervention group or a waiting list control group. In addition, we aim to include 63 patients with haematological cancer in a non-central nervous system malignancy control group. Assessments take place at baseline, after 6 and 12 weeks, and after 6 and 12 months. Primary outcome measure is the change in depressive symptoms. Secondary outcome measures include health-related quality of life, fatigue, costs and patient satisfaction. In addition, all patients are asked to assign a primary informal caregiver, who does not participate in the intervention but who is asked to complete similar assessments. Their mood, health-related quality of life and fatigue is evaluated as well.DiscussionThis is the first study to evaluate the effects of problem-solving therapy delivered through the internet as treatment for depressive symptoms in glioma patients. If proven effective, this treatment will contribute to the mental health care of glioma patients in clinical practice.Trial registrationNetherlands Trial Register NTR3223

Highlights

Among glioma patients, depression is estimated to be more prevalent than in both the general population and the cancer patient population
This is the first study to evaluate the effects of problem-solving therapy delivered through the internet as treatment for depressive symptoms in glioma patients
This treatment will contribute to the mental health care of glioma patients in clinical practice

Summary

Introduction

Depression is estimated to be more prevalent than in both the general population and the cancer patient population. Patients can experience shock and disbelief, dysphoria, despair, anger and anxiety, and intrusive thoughts about their diagnosis [15] These issues may cause an adjustment disorder to the situation, which if persistent, can become a major depressive episode [16]. Evidence for this theory is inconclusive as awareness of the prognosis is not always associated with mood disorders [17]. These mechanisms occur in other cancer patient populations as well, which only emphasizes the unexpectedly high prevalence of depression among glioma patients,

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