J. Med. Internet Res. - The clinical effectiveness of web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: randomized controlled trial.

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Resumo

CKGROUND: Most patients with mild to moderate depression receive treatment in primary care, but despite guideline recommendations, structured psychological interventions are infrequently delivered. Research supports the effectiveness of Internet-based treatment for depression; however, few trials have studied the effect of the MoodGYM program plus therapist support. The use of such interventions could improve the delivery of treatment in primary care.OBJECTIVE: To evaluate the effectiveness and acceptability of a guided Web-based intervention for mild to moderate depression, which could be suitable for implementation in general practice.METHODS: Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition comprising 6 weeks of therapist-assisted Web-based cognitive behavioral therapy (CBT), or to a 6-week delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, brief face-to-face support from a psychologist, and reminder emails. The primary outcome measure, depression symptoms, was measured by the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Beck Anxiety Inventory (BAI), the Hospital Anxiety and Depression Scale (HADS), the Satisfaction with Life Scale (SWLS), and the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D). All outcomes were based on self-report and were assessed at baseline, postintervention, and at 6-month follow-up.RESULTS: Postintervention measures were completed by 37 (71%) and 47 (87%) of the 52 participants in the intervention and 54 participants in the delayed treatment group, respectively. Linear mixed-models analyses revealed a significant difference in time trends between the groups for the BDI-II, (P=.002), for HADS depression and anxiety subscales (P<.001 and P=.001, respectively), and for the SWLS (P<.001). No differential group effects were found for the BAI and the EQ-5D. In comparison to the control group, significantly more participants in the intervention group experienced recovery from depression as measured by the BDI-II. Of the 52 participants in the treatment program, 31 (60%) adhered to the program, and overall treatment satisfaction was high. The reduction of depression and anxiety symptoms was largely maintained at 6-month follow-up, and positive gains in life satisfaction were partly maintained.CONCLUSIONS: The intervention combining MoodGYM and brief therapist support can be an effective treatment of depression in a sample of primary care patients. The intervention alleviates depressive symptoms and has a significant positive effect on anxiety symptoms and satisfaction with life. Moderate rates of nonadherence and predominately positive evaluations of the treatment also indicate the acceptability of the intervention. The intervention could potentially be used in a stepped-care approach, but remains to be tested in regular primary health care.TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12610000257066; http://apps.who.int/trialsearch/trial.aspx?trialid=ACTRN12610000257066 (Archived by WebCite at http://www.webcitation.org/6Ie3YhIZa).

Resumo Limpo

ckground patient mild moder depress receiv treatment primari care despit guidelin recommend structur psycholog intervent infrequ deliv research support effect internetbas treatment depress howev trial studi effect moodgym program plus therapist support use intervent improv deliveri treatment primari careobject evalu effect accept guid webbas intervent mild moder depress suitabl implement general practicemethod particip n age year recruit primari care random alloc treatment condit compris week therapistassist webbas cognit behavior therapi cbt week delay treatment condit intervent includ norwegian version moodgym program brief facetofac support psychologist remind email primari outcom measur depress symptom measur beck depress inventoryii bdiii secondari outcom measur includ beck anxieti inventori bai hospit anxieti depress scale had satisfact life scale swls euroqol group dimens selfreport questionnair eqd outcom base selfreport assess baselin postintervent month followupresult postintervent measur complet particip intervent particip delay treatment group respect linear mixedmodel analys reveal signific differ time trend group bdiii p had depress anxieti subscal p p respect swls p differenti group effect found bai eqd comparison control group signific particip intervent group experienc recoveri depress measur bdiii particip treatment program adher program overal treatment satisfact high reduct depress anxieti symptom larg maintain month followup posit gain life satisfact part maintainedconclus intervent combin moodgym brief therapist support can effect treatment depress sampl primari care patient intervent allevi depress symptom signific posit effect anxieti symptom satisfact life moder rate nonadher predomin posit evalu treatment also indic accept intervent intervent potenti use steppedcar approach remain test regular primari health caretri registr australian new zealand clinic trial registri actrn httpappswhointtrialsearchtrialaspxtrialidactrn archiv webcit httpwwwwebcitationorgieyhiza

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