Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 21, 2022
Date Accepted: Jul 31, 2023
The Effect of Internet-based Cognitive Behavioral Therapy on Major Depressive Disorder: Randomized Controlled Trial
ABSTRACT
Background:
Many persons living with major depressive disorder (MDD) in China do not receive treatment due to a lack of mental health services, along with significant stigma towards mental illness. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase access to mental health care for persons with MDD.
Objective:
The aims of this study were to: (1) evaluate the efficacy of ICBT on depressive symptoms in patients with MDD; (2) evaluate the effect of ICBT on anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social function, and health-related quality of life (HRQoL); (3) explore the acceptability of and satisfaction with the ICBT program among participants.
Methods:
Patients with MDD were enrolled and randomized to the ICBT group or the waiting-list controlled (WLC) group. The ICBT group received ICBT delivered through a WeChat mini-program with general support by non-specialists. Participants in two groups were online self-evaluated at baseline and post-treatment assessment for change of primary outcome (i.e., depressive symptoms) and secondary outcomes (i.e., anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social functional impairment, and HRQoL), the change was measured by a change in overall score on the respective scale, and the response and remission rates were calculated based on depressive symptoms. The acceptability of and satisfaction with the ICBT program was measured by treatment adherence and participants' feelings (i.e., modules seriously completed, perceived benefit, satisfaction).
Results:
We included 40 patients who were randomly assigned to the ICBT group and 44 to the WLC group. Compared with the WLC group, the ICBT group had less depressive symptoms, anxiety symptoms, nonspecific psychological distress, depression stigma, and social functional impairment, while greater general self-efficacy (all P values <.05). Moreover, the ICBT group reported higher response (58.1%) and remission rates (54.8%). Adherence of the ICBT group was 77.5%, and the majority of participants who completed all ICBT modules were satisfied with the ICBT program.
Conclusions:
Internet-based cognitive behavioral therapy demonstrated improvements in depressive symptoms, anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, and social function in persons with MDD in comparison to the WLC group. The ICBT program in this study had nice acceptability and satisfaction among participants. Clinical Trial: Chinese Clinical Trial Registry: ChiCTR2100046425; http://www.chictr.org.cn/showprojen.aspx?proj=125982
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.