JMIR Publications

ABSTRACT

Background:

Internet- and mobile based interventions are most efficacious in the treatment of depression when they involve some form of guidance, but providing guidance requires resources such as trained personnel that might not always be available, e.g. during the lockdown to contain the COVID-19 Pandemic.

Objective:

The current analysis focusses on changes in symptoms of depression in a guided- compared to an unguided sample of patients with depression who registered for an internet-based intervention, the iFightDepression tool, including the extent of intervention use. The objective is to further understand the effect of guidance and adherence on the interventions’ potential to induce symptom change.

Methods:

Log data from two convenience samples in German routine care was used to assess symptom change after 6-9 weeks of intervention as well as minimal dose (finishing at least two workshops). A linear regression model with changes in the Patient Health Questionnaire (PHQ-9) as dependent variable and guidance and minimal dose as well as their interaction as independent variables was specified.

Results:

Data from a of 1.423 people with symptoms of depression (66.1% guided) were included in the current analysis. In the linear regression model predicting symptom change, a significant interaction of guidance and minimal dose revealed a specifically greater improvement for patients who received guidance and also worked with the intervention content (β = -1.75, t = -2.37, P = .018), while there was little difference in symptom change due to guidance in the group that did not use the intervention. In this model, the main effect of guidance was only marginally significant (β = -0.53, t = -1.78, P = .076).

Conclusions:

Guidance in internet-based interventions for depression is not only an important factor to facilitate adherence, but seems to further improve the effects for patients adhering to the intervention compared to those who do the same but without guidance.