Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 4, 2024
Date Accepted: Apr 2, 2026
Long-Term Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder in Chinese Adults: A Randomized Controlled Trial with A 12-month Follow-Up
ABSTRACT
Background:
Unguided internet-based cognitive behavioral therapy (ICBT) is a low-cost and scalable treatment for major depressive disorder (MDD), but its long-term effects in Chinese populations remain unclear.
Objective:
This study aimed to (1) explore the short- and long-term effectiveness of unguided ICBT in treating adults with MDD; (2) investigate the short- and long-term effects on disease-related symptoms, individual and social functioning, and quality of life; (3) assess the acceptability and satisfaction with the ICBT.
Methods:
An 8-week randomized controlled trial (ChiCTR2100046425) was conducted between August 2021 and June 2023 in Shenzhen, China, with 159 participants in the immediate ICBT group (7-module ICBT course plus usual care) and 158 in the waitlist control (WLC) group (usual care). The WLC group later completed the same ICBT course and follow-up assessments. Outcome measures (depressive and anxiety symptoms, psychological distress, social functioning, self-efficacy, quality of life, and stigma) were assessed pre- and post-treatment and at 3-, 6-, and 12-month follow-ups for ICBT participants. Remission and response, adherence, and satisfaction were evaluated by pre-defined standards.
Results:
Among 300 participants analyzed (mean age 28.49±7.0 years, 75% female), dropout rates were 22.4% in the immediate ICBT group versus 6.3% in the WLC group. At post-treatment, the immediate ICBT group showed greater reduction in depressive symptoms vs. WLC (mean difference -3.65, P<.001, d=.50), with higher remission (66.1% vs. 39.2%, P<.001) and response rates (41.3% vs. 18.2%, P<.001). At 12-month follow-up, the depressive symptoms were improved compared with that at pretreatment (mean difference -3.90; P<.001; d=.70) and no significant change was observed in comparison with the outcomes at posttreatment (mean difference -0.81; P=.33; d=-.15). ICBT treatment also exhibited similar short- and long-term effects on secondary outcomes with significant improvement of disease-related symptoms, individual and social functioning, and quality of life. Moreover, the majority of the participants treated with ICBT reported high acceptability of and satisfaction with the ICBT course.
Conclusions:
Unguided ICBT effectively reduces depressive symptoms and enhances functioning in Chinese MDD patients, with sustained benefits over 12 months. Its scalability and low-cost nature make it a promising option for resource-limited settings. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2100046425; https://tinyurl.com/bdcrj4zv
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