JMIR Publications

ABSTRACT

Background:

Primary Care (PC) is a major access point for initial treatment of depression, but the management of these patients is far from optimal. The lack of time in PC is one of the most important difficulties for the delivery of evidence-based psychotherapy. During the last decade research has focused on the development of brief psychotherapy and cost-effective Internet-based interventions mostly based on Cognitive Behavioural Therapy (CBT). However, less research has focused on alternative methods of treatment to CBT for depression. Thus, there is a need for research into other therapeutic approaches.

Objective:

The aim of the present study was to assess the effectiveness of three low intensity Internet-based psychological interventions (healthy lifestyle psychoeducational program (HLP), focused program on positive affect promotion (PAPP) and brief intervention based on Mindfulness (MP)) compared to a control condition (iTAU).

Methods:

A multicenter, four-arm, parallel, randomized controlled trial (RCT) was carried out between March 2015 and March 2016, with a follow-up of 12 months. 221 adults with mild or moderate major depression were recruited in PC settings from three Spanish regions. Patients were randomly distributed to iTAU (n=57), HLP (n=54), PAPP (n=56), and MP (n=54). All patients received iTAU from their general practitioners. The main outcome was the Spanish version of Patient Health Questionnaire-9 (PHQ-9) from pre-treatment (time 1) to post-treatment (time 2), and up to 6 (time 3) and 12 (time 4) months follow-up. Secondary outcomes included the Visual Analogue Scale of the EuroQoL (VAS EQ-5D), the Short Form Health Survey (SF-12v1), the Positive and Negative Affect Schedule (PANAS), and The Pemberton Happiness Index (PHI). We conducted regression models to estimate outcome differences along study stages.

Results:

A moderate decrease was detected in PHQ-9 scores from HLP (B=-3.05, p=.012) and MP (B=-3.00, p=.013) compared to iTAU at post-treatment. There were significant differences between all intervention groups and iTAU in physical SF-12 scores at 6 months after treatment. Regarding to well-being, MP and PAPP reported better PHI results than iTAU at 6 months’ post-treatment. PAPP intervention significantly decreased PANAS Negative affect scores compared to iTAU 12 months after treatment.

Conclusions:

Two low-intensity Internet-based psychological intervention (HLP and MP) for the treatment of depression in PC, are more effective than iTAU at post-treatment. Moreover, all low-psychological interventions are also effective in improving medium- and long-term quality of life. Finally, PAPP is effective for improving health related quality of life, negative affect and wellbeing in depressive patients. Nevertheless, it is important to examine possible reasons that could be implicated in the result that PAPP seems not to be effective for reducing depressive symptomatology, as well as, more research is still needed to assess the cost-effectiveness analysis of these interventions. Clinical Trial: Current Controlled Trials ISRCTN82388279. Registered 16 April 2014.