JMIR Publications

ABSTRACT

Background:

Complementing the treatment of depression with internet based self-management interventions has been shown to be efficacious. However, evidence for their efficacy has mainly been derived from comparisons to waitlist or treatment as usual controls. These conditions are not likely to induce hope, but to maybe even have nocebo instead of placebos effects, making it difficult to draw conclusions about the intervention’s efficacy. Studies applying more rigorous designs, e.g. by using active controls, are rare and have not yielded conclusive results.

Objective:

The objective of the current study was to compare the effects of a guided, web-based self-management intervention to an active control. The primary objective was to compare changes in symptom severity between both conditions. Secondary objectives focused on analyzing possible covariates influencing the changes in symptom severity as well as differences between both conditions with respect to user experience and changes in quality of life.

Methods:

In a randomized controlled trial, a guided CBT based online self-management intervention (iFightDepression) was tested against an active control condition (progressive muscle relaxation). A total of 348 patients with mild to moderate depressive symptoms or dysthymia were recruited online and randomly assigned to one of the two six-week intervention arms. Symptoms of depression (IDS-SR) as well as quality of life (SF12) and user satisfaction (CSQ-8) were measured in self-report before and after three and six weeks of intervention. The analyses were performed applying mixed models.

Results:

Changes in symptoms of depression occurred over time (iFightDepression: d = -0.619, 95% CI[-0.860, -0.370], control: d = -0.541, 95% CI[-0.790, -0.291]), but were not statistically significantly different between intervention and control group (d = 0.228, 95% CI[-0.015, 0.471]) and none of the covariates tested had a significant explanatory value for the intervention effect. iFightDepression was significantly superior to the control condition with respect to improved mental quality of life (d = -0.280, 95% CI[-0.036, -0.525]) and user satisfaction (25.31 vs. 21.97, t(259) = 5.804, P < .01). The usage of both interventions was sufficiently similar (iFightDepression: 6.2 hours, control: 6.5 hours spent on the intervention on average), and the average time spent on guidance was acceptable (iFightDepression: 38.5 min, control: 28.9 min).

Conclusions:

Both interventions were associated with a reduction in symptoms of depression. The effects on quality of life as well as user satisfaction ratings were superior for the online self-management intervention. Our results implicate that the effect of web-based interventions on symptoms of depression might be smaller than suggested by earlier studies using wait list or TAU control conditions. However, since self-management tools are not a replacement for antidepressants or face-to-face therapy, even small effects can be cost effective. Clinical Trial: International Clinical Trials Registry Platform (ICTRP), ID 080-15-09032015