Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial

BMC Psychiatry

Claire Hayes¹  Ciara Joyce⁴  Amy Colla⁴  John Sharry⁵  Gavin Doherty³  Ladislav Timulak⁶  Derek Richards² 

[1] Aware Charity Ireland, 72 Lower Leeson Street, Dublin 2, Ireland;School of Psychology, Trintiy College, Dublin, Ireland;School of Computer Science and Statistics, University of Dublin, Trintiy College, Dublin, Ireland;SilverCloud Health Ltd, Dublin, Ireland;Mater Misericordiae University Hospital, Dublin, Ireland;School of Psychology, University of Dublin, Trintiy College, Dublin, Ireland

关键词: Internet-delivered;    Symptoms;    Randomized trial;    CBT;    Treatment;    Online interventions;    Depression;   

Others  :  1123571
DOI  :  10.1186/1471-244X-14-147

 received in 2013-12-04, accepted in 2014-05-14,  发布年份 2014

【 摘 要 】

Background

Depression is a high prevalence disorder, displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. In Ireland 12-month prevalence of depression has been reported to be 10.3%. A large percentage of affected individuals have no medical diagnosis nor seek treatment. Cognitive Behavior Therapy (CBT) has established itself as an option for the treatment of depression. Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult.

Stepped-care can increase access to evidence-based CBT. One option is tailored internet-delivered treatment programs. Preliminary research from Ireland needs now to include large-scale studies on effectiveness. Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample.

Method/Design

The study is a randomized controlled trial of an online CBT (iCBT) program for the treatment of adults with depressive symptoms. The trial will include an active treatment group and a waiting-list control group. The active condition will consist of 8 weekly modules of iCBT, with post-session feedback support. Participants in the waiting list will receive access to the treatment at week 8. Participants will complete the Beck Depression Inventory (BDI-II) and eligibility criteria will also apply. Primary outcomes are depressive symptoms. Secondary outcomes include quality of life indicators, significant events and satisfaction with online treatment. Data will be collected at baseline and at post-treatment, week 8, and at follow-up week 20 (3-months) and week 32 (6-months). Analysis will be conducted on the intention-to-treat basis.

Discussion

The study seeks to evaluate the effectiveness of an online delivered treatment for depression in a community sample of Irish adults with symptoms of depression. The study will be a first contribution and depending on the sample recruited the results may be generalizable to people with similar difficulties in Ireland and may therefore give insight into the potential of low-intensity interventions for Irish people with depressive symptoms.

Trial registration number

Current Controlled TrialsISRCTN03704676. DOI: 10.1186/ISRCTN03704676

【 授权许可】

   
2014 Richards et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mathers CD, Loncar D: Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006, 3:e442.
• [2]Richards D: Prevalence and clinical course of depression: a review. Clin Psychol Rev 2011, 31:1117-1125.
• [3]Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS: The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003, 289:3095-3105.
• [4]Ayuso-Mateos JL, Vazquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, Wilkinson C, Lasa L, Page H, Dunn G, Wilkinson G: Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry 2001, 179:308-316.
• [5]Copeland JR, Beekman AT, Braam AW, Dewey ME, Delespaul P, Fuhrer R, Hooijer C, Lawlor BA, Kivela SL, Lobo A, Magnusson H, Mann AH, Meller I, Prince MJ, Reischies F, Roelands M, Skoog I, Turrina C, de Vries MW, Wilson KC: Depression among older people in Europe: the EURODEP studies. World Psychiatry 2004, 3:45-49.
• [6]Craighead WE, Sheets ES, Brosse AL, Ilardi SS: Psychosocial Treatments for Major Depressive Disorder. In A Guide to Treatments That Work. 3rd edition. Edited by Nathan PE, Gorman JM. New York: Oxford University Press; 2007.
• [7]Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK: The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 2003, 64:1465-1475.
• [8]Sobocki P, Jönsson B, Angst J, Rehnberg C: Cost of depression in Europe. J Ment Health Policy Econ 2006, 9:87-98.
• [9]Cuijpers P, Schoevers R: Increased mortality in depressive disorders: a review. Curr Psych Reports 2004, 6:430-437.
• [10]Rapaport MH, Clary C, Fayyad R, Endicott J: Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry 2005, 162:1171-1178.
• [11]Van Schaik D, Klijn A, Van Hout H: Patients preferences in the treatment of depressive disorders in primary care. Gen Hosp Psychiatry 2004, 26:184-189.
• [12]Cuijpers P, Van Straten A, Van Oppen P, Andersson G: Are psychological and pharmacological interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. J Clin Psychiatry 2008, 69:1675-1685.
• [13]National Institute for Health and Clinical Excellence: Computerised Cognitive Behaviour Therapy for Depression and Anxiety. Technology Appraisal 97. London: National Institute for Health and Clinical Excellence; 2006.
• [14]Hollon SD, DeRubeis RJ: Effectiveness of Treatment for Depression. In Contemporary Cognitive Therapy: Theory, Research, and Practice. Edited by Leahy RL. New York: Guildford Press; 2006:45-61.
• [15]Beck AT: The current state of cognitive therapy: a 40-year retrospective. Arch Gen Psychiatry 2005, 62:953-959.
• [16]Beck AT, Rush AJ, Shaw BF, Emery G: Cognitive Therapy of Depression. New York: Guilford Press; 1979.
• [17]Alloy LB, Abramson LY, Hogan ME, Whitehouse WG, Rose DT, Robinson MS, Kim RS, Lapkin JB: The temple-wisconsin cognitive vulnerability to depression project: lifetime history of axis I psychopathology in individuals at high and low cognitive risk for depression. J Abnorm Psychol 2000, 109:403-418.
• [18]Abramson LY, Alloy LB, Hankin BL, Haeffel GJ, MacCoon DG, Gibb BE: Cognitive Vulnerability-Stress Model of Depression in a Self-Regulatory and Psychobiological Context. In Handbook of Depression. Edited by Gotlib IH, Hammen CL. New York: Guilford; 2002:268-294.
• [19]Beck AT: Depression: Causes and Treatment. Philadelphia: University of Pennsylvania Press; 1967. 1972
• [20]Ingram RE, Luxton DD: Vulnerability-Stress Models. In Development of Psychopathology: A Vulnerability-Stress Perspective. Edited by Hankin BL, Abela JRZ. California: Sage; 2005.
• [21]Andrews G, Sanderson K, Slade T, Issakidis C: Why Does the Burden of Disease Persist? Relating the Burden of Anxiety and Depression to Effectiveness of Treatment. In Bulletin World Health Organisation, vol. 78. Geneva: World Health Organisation; 2000:446-454.
• [22]Kohn R, Saxena S, Levav I, Saraceno B: The treatment gap in mental health care. Bull World Health Organ 2004, 82:858-866.
• [23]Mohr DC, Ho J, Duffecy J, Baron KG, Lehman KA, Jin L, Reifler D: Perceived barriers to psychological treatments and their relationship to depression. J Clin Psychol 2010, 66:394-409.
• [24]Royal College of Psychiatrists: Mental Health of Students in Higher Education. London: Royal College of Psychiatrists; 2011:97. 97
• [25]Department of Health and Children: Avision for Change: Report of the Expert Group on Mental Health Policy. Dublin: Stationary office; 2006.
• [26]Copty M: Mental Health in Primary Care. Dublin: Irish College of General Practitioners/South Western Area Health Board; 2004.
• [27]Hughes M, Byrne M, Synnott J: Prevalence of psychological distress in general practitioner adult attendees. Clin Psychol Forum 2010, 206:33-38.
• [28]Tedstone-Doherty D, Moran R, Kartalova-O’Doherty Y: Psychological Distress, Mental Health Problems and use of Health Services in Ireland. Health Research Board (HRB) Research Series 5. Dublin: HRB; 2008.
• [29]Bennett-Levy J, Richards DA, Farrand P: Low Intensity CBT Interventions: A Revolution in Mental Healthcare. In Oxford Guide to low Intensity CBT Interventions. Edited by Bennett-Levy J, Richards DA, Farrand P, Christensen H, Griffiths KM, Kavanagh DJ, Klein B, Lau MA, Proudfoot J, Ritterband L, White J, Williams C. Oxford: Oxford University Press; 2010:3-18.
• [30]Health Service Executive: Advancing the Shared Care Approach between Primary care and Specialist Mental Health Services. Dublin: Health Service Executive; 2012:27.
• [31]Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B: Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behav Res Ther 2009, 47:910-920.
• [32]Marks IM, Cavanagh K, Gega L: Hands on Help: Computer-Aided Psychotherapy. Hove: Psychology Press; 2007.
• [33]Bennett-Levy J, Richards DA, Farrand P, Christensen H, Griffiths KM, Kavanagh DJ, Klein B, Lau MA, Proudfoot J, Ritterband L, White J, Williams C (Eds): Low Intensity CBT Interventions. Oxford: Oxford University Press; 2010.
• [34]Richards D, Richardson T: Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev 2012, 32:329-342.
• [35]Andersson G, Cuijpers P: Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther 2009, 38:196-205.
• [36]Internet users in Europe [http://www.internetworldstats.com/stats4.htm webcite]
• [37]Richards D, Timulak L, Hevey D: A comparison of two online cognitive-behavioural interventions for symptoms of depression in a student population: the role of therapist responsiveness. Couns Psychother Res 2013, 13:184-193.
• [38]Sharry J, Davidson R, McLoughlin O, Doherty G: A service-based evaluation of a therapist-supported online cognitive behavioural therapy programme for depression. J Med Internet Res 2013, 15:e121.
• [39]Richards D, Timulak L, Hevey D: A comparison of two online cognitive-behavioural interventions for symptoms of depression in a student population: the role of therapist responsiveness. Couns Psychother Res 2012, 13:1-10.
• [40]Eysenbach G: The Law of Attrition. J Med Internet Res 2005, 7:e11.
• [41]Warmerdam L, Van Straten A, Twisk J, Riper H, Cuijpers P: Internet-based treatment for adults with depressive symptoms: randomized controlled trial. J Med Internet Res 2008, 10:e44.
• [42]Andersson G, Bergstorm J, Holländare F, Varlbring P, Kaldo V, Ekselius L: Internet-based self-help for depression: randomised controlled trial. Br J Psychiatry 2005, 187:456-461.
• [43]Clarke G, Kelleher C, Hornbrook M, DeBar L, Dickerson J, Gullion C: Randomized effectiveness trial of an Internet, pure self-help, cognitive behavioral intervention for depressive symptoms in young adults. Cogn Behav Ther 2009, 38:222-234.
• [44]De Graaf LE, Gerhards SAH, Arntz A, Riper H, Metsemakers JFM, Evers SMAA, Severens JL, Widdershoven G, Huibers MJH: Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Br J Psychiatry 2009, 195:73-80.
• [45]Meyer B, Berger T, Caspar F, Beevers GC, Andersson G, Weiss M: Effectiveness of a novel integrative online treatment for depression (deprexis): randomized controlled trial. J Med Internet Res 2009, 11:e15.
• [46]Ruwaard J, Schrieken B, Schrijver M, Broeksteeg J, Dekker J, Vermeulen H, Lange A: Standardized Web-based CBT of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cogn Behav Ther 2009, 38:1-19.
• [47]Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K: Internet treatment for depression: a randomized controlled trial comparing clinician vs. Technician assistance. PLoS One 2010., 5
• [48]Vernmark K, Lenndin J, Bjärehed J, Carlsson M, Karlsson J, Öberg J, Carlbring P, Eriksson T, Andersson G: Internet administered guided self-help versus individualized e-mail therapy: a randomized trial of two versions of CBT for major depression. Behav Res Ther 2010, 48:368-376.
• [49]Faul F, Erdfelder E, Lang A-G, Buchner A: G*Power 3: A Flexible Statistical Power Analysis for the Social, Behavioral, and Biomedical Sciences. Behavior Research Methods, Instruments, & Computers 2007, 39.
• [50]Beck AT, Steer RA, Brown GK: Manual for the BDI-II. San Antonio, TX: Psychological Corporation; 1996.
• [51]American Psychiatric Association [APA]: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th edition. Washington D.C: American Psychiatric Association; 2000.
• [52]Arnau RC, Meagher MW, Norris MP, Bramson R: Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol 2001, 20:112-119.
• [53]Steer RA, Rissmiller DJ, Beck AT: Use of the Beck Depression Inventory-II with depressed geriatric inpatients. Behav Rese Ther 2000, 38:311-318.
• [54]Beck AT, Steer RA, Garbin MG: Psychometric properties of the beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev 1988, 8:77-100.
• [55]Spitzer RL, Kroenke K, Williams JW, Löwe B: A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006, 166:1092-1097.
• [56]Kroenke K, Spitzer RL, Williams JBW, Löwe B: The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010, 32:345-359.
• [57]Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY: Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 2008, 46:266-274.
• [58]Richards DA, Suckling R: Improving access to psychological therapies: phase IV prospective cohort study. Br J Clin Psychol 2009, 48:377-396.
• [59]Mundt JC, Marks IM, Shear MK, Greist JM: The work and social adjustment scale: a simple measure of impairment in functioning. Br J Psychiatry 2002, 180:461-464.
• [60]Rabin R, Oemar M, Oppe M: EQ-5D-3L User Guide: Basic Information on how to use the EQ-5D-3L Instrument. 40th edition. Rotterdam: The Netherlands: EuroQol Group; 2011.
• [61]Elliott R, Slatick E, Urman M: Qualitative Change Process Research on Psychotherapy: Alternative Strategies. In Qualitative Psychotherapy Research: Methods and Methodology. Edited by Frommer J, Rennie DL. Lengerich, Germany: Pabst Science Publishers; 2001:69-111.
• [62]Llewelyn SP, Elliott R, Shapiro DA, Hardy G, Firth-Cozens J: Client perceptions of significant events in prescriptive and exploratory periods of individual therapy. Br J Clin Psychol 1988, 27:105-114.
• [63]Hevey D, McGee HM, Horgan JH: Responsiveness of health-related quality of life outcome measures in cardiac rehabilitation: Comparison of cardiac rehabilitation outcomes measures. J Consult Clin Psychol 2004, 72:1175-1180.
• [64]Cohen J: Statistical power analysis for the behavioral sciences. 2nd edition. Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.
• [65]Jacobson NS, Truax P: Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991, 59:12-19.
• [66]Elliott R, Timulak L: Descriptive and Interpretative Approaches to Qualitative Research. In A Handbook of Research Methods in Clinical and Health Psychology. Edited by Miles J, Gilbert P. Oxford: Oxford University Press; 2005:147-160.
• [67]Richards D, Timulak L: Client-identified helpful and hindering events in therapist-delivered vs. self-administered online cognitive-behavioural treatments for depression in college students. Couns Psychol Q 2012, 25:251-262.
• [68]Richards D, Timulak L: Satisfaction with therapist-delivered vs. self-administered online cognitive-behavioural treatments for depression symptoms in college students. Br J Guid Counc 2012, 41:193-207.