JMIR Publications

ABSTRACT

Background:

People with type 2 diabetes often experience mental health symptoms that impair functioning, exacerbate illness and increase mortality risk. Access to psychological support is typically low in people with type 2 diabetes. Detection of depression is variable in the primary care setting and can be further impacted by the stigma attached to mental health conditions. Electronic mental health (eMH) programs may provide an accessible, private, non-stigmatising mental health solution for this group.

Objective:

To evaluate the efficacy of an eMH program (myCompass) for improving social and occupational functioning in a community sample of people with type 2 diabetes and self-reported mild-to-moderate depressive symptoms. myCompass is a fully-automated and self-guided online public health program for people with depression and/or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms and self-care behaviour were also examined.

Methods:

Adults with type 2 diabetes and mild-to-moderate depressive symptoms (n = 780) were recruited via online advertisements, community organisations and general practices. Screening, consent and self-report questionnaires were administered online. Eligible participants were randomised to receive either myCompass (n = 391) for 8 weeks plus a 4-week tailing off period, or an active attention control (n = 379). At baseline and at 3-, 6-, and 12-months post-intervention, participants completed the Work and Social Adjustment Scale (WSAS), the Patient Health Questionnaire-9 item (PHQ-9), Diabetes Distress Scale (DDS), Generalised Anxiety Disorder Questionnaire-7 item (GAD-7) and items from the Self-Management Profile for Type 2 Diabetes (SMP-T2D). Glycosylated haemoglobin (HbA1c) measures were obtained at baseline, 6- and 12-months post-intervention.

Results:

myCompass users logged-in an average of six times and completed an average of .29 modules. Healthy Lifestyles users logged-in an average of four times and completed an average of 1.37 modules. At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite a varied and extensive recruitment process. Of the 780 trial participants, 304 (39%) completed all post-intervention assessments. Intention-to-treat analyses revealed slightly greater improvement in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management and glycaemic control across the trial.

Conclusions:

The Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields insights into mental health research in the context of T2DM, particularly the issues of engagement with programs which focus specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. Clinical Trial: ACTRN12615000931572