Abstract
BackgroundDepression is twice as common in people with diabetes, and this comorbidity worsens the course of both pathologies. In clinical practice guidelines, screening and treatment of depression in patients with diabetes are highly recommended. However, depression is still both underrecognized and undertreated. To find ways to enhance their reach, psychological treatments have taken advantage of benefits of internet and technological devices as delivery formats, providing interventions that require considerably less (or even no) interaction time with therapists. Web-based treatments hold promise for effective interventions at low cost with positive results.ObjectiveThe objectives of this review were to describe Web-based interventions for depression in individuals with diabetes and to discuss these studies’ procedures and findings in light of evidence from a wider range of interventions for depression and diabetes.MethodsA comprehensive literature search was conducted in PsycINFO and MEDLINE electronic databases. Studies were included when they met the following selection criteria: the study was available in a peer-reviewed journal mainly publishing studies written in either English or Spanish; the studied sample comprised individuals with diabetes; the intervention targeted depression symptomatology; the intervention was accessible via the internet; and the intervention was accessible via the internet with little or no clinician support.ResultsOverall, 5 research studies were identified in the review. All studies were randomized controlled trials, and most used a wait list as a control; 4 studies reported treatment dropout, rates of which varied from 13% to 42%. Studies supported the notion that the Web-based format is a suitable psychology service delivery option for diabetic individuals with depression (effect size range for completers 0.7-0.89). Interventions varied in their characteristics but most were clinical-assisted, had a cognitive behavioral therapy approach, used diabetes-specific topics, had a weekly modular display, used homework assignments, and had some adherence management strategy. These characteristics are consistent with the intervention features associated with positive results in the literature.ConclusionsThe analyzed studies’ findings and procedures are discussed in light of evidence drawn from a wider range of reviews on Web-based interventions for depression and diabetes. Consistent with previous research on depression treatment, Web-based interventions for depression among individuals with diabetes have shown positive results. Future research should contribute new evidence as to why these interventions are effective, for whom, and which particular aspects can increase patients’ adherence.
Highlights
IntroductionSubstantial evidence shows that depression among individuals with diabetes is associated with poorer diabetes outcomes [1] and higher levels of diabetes distress (emotional burdens, stresses, and worries associated with diabetes) [2]
Studies were included when they met the following selection criteria: the study was available in a peer-reviewed journal mainly publishing studies written in either English or Spanish; the studied sample comprised individuals with diabetes; the intervention targeted depression symptomatology; the intervention was accessible via the internet; and the intervention was accessible via the internet with little or no clinician support
Substantial evidence shows that depression among individuals with diabetes is associated with poorer diabetes outcomes [1] and higher levels of diabetes distress [2]
Summary
Substantial evidence shows that depression among individuals with diabetes is associated with poorer diabetes outcomes [1] and higher levels of diabetes distress (emotional burdens, stresses, and worries associated with diabetes) [2]. Patients with diabetes show higher frequency of hypoglycemia and higher levels of glycosylated hemoglobin, their risk of developing diabetes-related complications increases [3,4,5] They show poorer adherence to self-care regimens, to medications, diet, and exercise [6,7]. Interesting are interventions requiring considerably less interaction time with the therapist than face-to-face psychotherapy (guided self-help approach) or even no interaction at all (unguided self-help approach) These treatments hold promise for low-cost interventions with positive results [22,23]. They may be beneficial to overcome logistical and financial obstacles burdening both health care providers and patients [24,25]. Web-based treatments hold promise for effective interventions at low cost with positive results
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