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Abstract
BackgroundDepression and diabetes are two highly prevalent and co-occurring health problems. Web-based, diabetes-specific cognitive behavioral therapy (CBT) depression treatment is effective in diabetes patients, and has the potential to be cost effective and to have large reach. A remaining question is whether the effectiveness differs between patients with seriously impaired mental health and patients with less severe mental health problems.ObjectiveTo test whether the effectiveness of an eight-lesson Web-based, diabetes-specific CBT for depression, with minimal therapist support, differs in patients with or without diagnosed major depressive disorder (MDD), diagnosed anxiety disorder, or elevated diabetes-specific emotional distress (DM-distress).MethodsWe used data of 255 patients with diabetes with elevated depression scores, who were recruited via an open access website for participation in a randomized controlled trial, conducted in 2008–2009, comparing a diabetes-specific, Web-based, therapist-supported CBT with a 12-week waiting-list control group. We performed secondary analyses on these data to study whether MDD or anxiety disorder (measured using a telephone-administered diagnostic interview) and elevated DM-distress (online self-reported) are effect modifiers in the treatment of depressive symptoms (online self-reported) with Web-based diabetes-specific CBT.ResultsMDD, anxiety disorder, and elevated DM-distress were not significant effect modifiers in the treatment of self-assessed depressive symptoms with Web-based diabetes-specific CBT.ConclusionsThis Web-based diabetes-specific CBT depression treatment is suitable for use in patients with severe mental health problems and those with a less severe clinical profile.ClinicalTrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 24874457; http://www.controlled-trials.com/ISRCTN24874457 (Archived by WebCite at http://www.webcitation.org/63hwdviYr)
Highlights
With an estimated world prevalence of 285 million people, diabetes mellitus has reached epidemic levels globally [1]
Web-based, diabetes-specific cognitive behavioral therapy (CBT) depression treatment is effective in diabetes patients, and has the potential to be cost effective and to have large reach
major depressive disorder (MDD), anxiety disorder, and elevated DM-distress were not significant effect modifiers in the treatment of self-assessed depressive symptoms with Web-based diabetes-specific CBT. This Web-based diabetes-specific CBT depression treatment is suitable for use in patients with severe mental health problems and those with a less severe clinical profile
Summary
With an estimated world prevalence of 285 million people, diabetes mellitus has reached epidemic levels globally [1]. Underrepresentation of complaints, underrecognition of depressive symptoms by health care providers, and inadequate referral can account for this [5,6]. Another reason for untreated depression in diabetes patients is the negative stigma of mental health care among patients who are treated in physical health care, or that they do not feel at home in a mental health care setting [7,8]. The VU University Medical Center in Amsterdam, The Netherlands, has recently developed such a cognitive behavioral therapy (CBT) depression intervention, tailored to the needs of diabetes patients by incorporating diabetes-specific topics, such as coping strategies for diabetes-specific issues [11]. A remaining question is whether the effectiveness differs between patients with seriously impaired mental health and patients with less severe mental health problems
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