Abstract
BackgroundAn earlier report indicated that callers to a telephone counseling service benefited from the addition of an evidence-based Web intervention for depression. It is not known whether the Web intervention would also lower alcohol use and stigma, or improve quality of life and knowledge of depression and its treatments.ObjectiveTo report the secondary outcomes of a trial of a Web-based cognitive behavior therapy (CBT) intervention for depression, including hazardous alcohol use, quality of life, stigma, depression literacy, and CBT literacy.MethodsWe recruited a sample of 155 callers to Lifeline, a national telephone counseling service in Australia, who met the criteria for moderate to high psychological distress. Participants were randomly assigned to 1 of 4 conditions: (1) Web CBT plus weekly telephone tracking, (2) Web CBT only, (3) weekly telephone tracking only, and (4) neither Web CBT nor telephone tracking. Participants were assessed at preintervention, postintervention, and 6 and 12 months postintervention.ResultsAt postintervention, participants who completed the Web intervention either with or without telephone support had lower levels of hazardous alcohol use (without tracking: P = .008, effect size = 0.23; with tracking: P = .003, effect size = 0.26), improved quality of life (without tracking: P = .001, effect size = 0.81; with tracking: P = .009, effect size = 0.63), and improved CBT literacy (without tracking: P = .01, effect size = 0.71; with tracking: P < .001, effect size = 0.80) compared with those who did not receive the Web intervention or telephone support. Results for quality of life and CBT literacy were maintained at 6- and 12-month’s follow-up, but differences in hazardous alcohol use were not significantly different between conditions at 6 and 12 months. Although omnibus tests for depression literacy and stigma were nonsignificant, contrasts revealed that those in the Web-only condition showed significantly lower levels of stigma than participants in the control condition at postintervention. This was true for participants in the Web-only and Web plus tracking conditions at 6 months. Similarly, those in the Web-only and Web plus tracking conditions had significantly higher depression literacy at postintervention, and this was maintained in the Web-only condition at 6-months’ follow-up. No significant differences were found in depression literacy and stigma between conditions at 12 months.ConclusionsEvidence-based Web interventions for depression can be effective not only in reducing depression symptoms but also in improving other health outcomes, including quality of life, hazardous alcohol use, and knowledge about effective strategies for depression self-management.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 93903959; http://www.controlled-trials.com/ISRCTN93903959/ (Archived by WebCite at http://www.webcitation.org/65y61nSsH)
Highlights
Web-based, self-administered cognitive behavior therapy (CBT) programs have been shown to be effective in reducing symptoms of depression [1,2,3,4]
Reviews have suggested that the effects of these programs may be enhanced by the provision of guidance from therapists [4]. Based on their recent review of the evidence, Newman and colleagues assert that Web interventions with ongoing assistance from a therapist are superior to other modes of online delivery in the treatment of clinical levels of depression [5]
We found no significant differences between participants in each condition on any of the variables of interest: quality of life (F3,151 = .10, P = .96), hazardous alcohol use (F3,103 = .55, P = .65), stigma (F3,147 = 1.21, P = .31), depression literacy (F3,147 = .98, P = .40), and CBT literacy (F3,144 = 1.41, P .24)
Summary
Web-based, self-administered cognitive behavior therapy (CBT) programs have been shown to be effective in reducing symptoms of depression [1,2,3,4]. Reviews have suggested that the effects of these programs may be enhanced by the provision of guidance from therapists [4] Based on their recent review of the evidence, Newman and colleagues assert that Web interventions with ongoing assistance from a therapist are superior to other modes of online delivery in the treatment of clinical levels of depression [5]. They argue that Web interventions with less-intensive support (eg, those that involve either no human support or periodic monitoring from a nonspecialist) are more appropriate in the treatment of people with subthreshold mood disorders. It is not known whether the Web intervention would lower alcohol use and stigma, or improve quality of life and knowledge of depression and its treatments
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