J. Med. Internet Res. - Is a severe clinical profile an effect modifier in a Web-based depression treatment for adults with type 1 or type 2 diabetes? Secondary analyses from a randomized controlled trial.


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CKGROUND: Depression and diabetes are two highly prevalent and co-occurring health problems. Web-based, diabetes-specific cognitive behavioral therapy (CBT) depression treatment is effective in diabetes patients, and has the potential to be cost effective and to have large reach. A remaining question is whether the effectiveness differs between patients with seriously impaired mental health and patients with less severe mental health problems.OBJECTIVE: To test whether the effectiveness of an eight-lesson Web-based, diabetes-specific CBT for depression, with minimal therapist support, differs in patients with or without diagnosed major depressive disorder (MDD), diagnosed anxiety disorder, or elevated diabetes-specific emotional distress (DM-distress).METHODS: We used data of 255 patients with diabetes with elevated depression scores, who were recruited via an open access website for participation in a randomized controlled trial, conducted in 2008-2009, comparing a diabetes-specific, Web-based, therapist-supported CBT with a 12-week waiting-list control group. We performed secondary analyses on these data to study whether MDD or anxiety disorder (measured using a telephone-administered diagnostic interview) and elevated DM-distress (online self-reported) are effect modifiers in the treatment of depressive symptoms (online self-reported) with Web-based diabetes-specific CBT.RESULTS: MDD, anxiety disorder, and elevated DM-distress were not significant effect modifiers in the treatment of self-assessed depressive symptoms with Web-based diabetes-specific CBT.CONCLUSIONS: This Web-based diabetes-specific CBT depression treatment is suitable for use in patients with severe mental health problems and those with a less severe clinical profile. CLINICALTRIAL: International Standard Randomized Controlled Trial Number (ISRCTN): 24874457; http://www.controlled-trials.com/ISRCTN24874457 (Archived by WebCite at http://www.webcitation.org/63hwdviYr).

Resumo Limpo

ckground depress diabet two high preval cooccur health problem webbas diabetesspecif cognit behavior therapi cbt depress treatment effect diabet patient potenti cost effect larg reach remain question whether effect differ patient serious impair mental health patient less sever mental health problemsobject test whether effect eightlesson webbas diabetesspecif cbt depress minim therapist support differ patient without diagnos major depress disord mdd diagnos anxieti disord elev diabetesspecif emot distress dmdistressmethod use data patient diabet elev depress score recruit via open access websit particip random control trial conduct compar diabetesspecif webbas therapistsupport cbt week waitinglist control group perform secondari analys data studi whether mdd anxieti disord measur use telephoneadminist diagnost interview elev dmdistress onlin selfreport effect modifi treatment depress symptom onlin selfreport webbas diabetesspecif cbtresult mdd anxieti disord elev dmdistress signific effect modifi treatment selfassess depress symptom webbas diabetesspecif cbtconclus webbas diabetesspecif cbt depress treatment suitabl use patient sever mental health problem less sever clinic profil clinicaltri intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctn archiv webcit httpwwwwebcitationorghwdviyr

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