J. Med. Internet Res. - Web-based cognitive behavior therapy for depression with and without telephone tracking in a national helpline: secondary outcomes from a randomized controlled trial.

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Resumo

CKGROUND: An earlier report indicated that callers to a telephone counseling service benefited from the addition of an evidence-based Web intervention for depression. It is not known whether the Web intervention would also lower alcohol use and stigma, or improve quality of life and knowledge of depression and its treatments.OBJECTIVE: To report the secondary outcomes of a trial of a Web-based cognitive behavior therapy (CBT) intervention for depression, including hazardous alcohol use, quality of life, stigma, depression literacy, and CBT literacy.METHODS: We recruited a sample of 155 callers to Lifeline, a national telephone counseling service in Australia, who met the criteria for moderate to high psychological distress. Participants were randomly assigned to 1 of 4 conditions: (1) Web CBT plus weekly telephone tracking, (2) Web CBT only, (3) weekly telephone tracking only, and (4) neither Web CBT nor telephone tracking. Participants were assessed at preintervention, postintervention, and 6 and 12 months postintervention.RESULTS: At postintervention, participants who completed the Web intervention either with or without telephone support had lower levels of hazardous alcohol use (without tracking: P = .008, effect size = 0.23; with tracking: P = .003, effect size = 0.26), improved quality of life (without tracking: P = .001, effect size = 0.81; with tracking: P = .009, effect size = 0.63), and improved CBT literacy (without tracking: P = .01, effect size = 0.71; with tracking: P < .001, effect size = 0.80) compared with those who did not receive the Web intervention or telephone support. Results for quality of life and CBT literacy were maintained at 6- and 12-month's follow-up, but differences in hazardous alcohol use were not significantly different between conditions at 6 and 12 months. Although omnibus tests for depression literacy and stigma were nonsignificant, contrasts revealed that those in the Web-only condition showed significantly lower levels of stigma than participants in the control condition at postintervention. This was true for participants in the Web-only and Web plus tracking conditions at 6 months. Similarly, those in the Web-only and Web plus tracking conditions had significantly higher depression literacy at postintervention, and this was maintained in the Web-only condition at 6-months' follow-up. No significant differences were found in depression literacy and stigma between conditions at 12 months.CONCLUSIONS: Evidence-based Web interventions for depression can be effective not only in reducing depression symptoms but also in improving other health outcomes, including quality of life, hazardous alcohol use, and knowledge about effective strategies for depression self-management.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 93903959; http://www.controlled-trials.com/ISRCTN93903959/ (Archived by WebCite at http://www.webcitation.org/65y61nSsH).

Resumo Limpo

ckground earlier report indic caller telephon counsel servic benefit addit evidencebas web intervent depress known whether web intervent also lower alcohol use stigma improv qualiti life knowledg depress treatmentsobject report secondari outcom trial webbas cognit behavior therapi cbt intervent depress includ hazard alcohol use qualiti life stigma depress literaci cbt literacymethod recruit sampl caller lifelin nation telephon counsel servic australia met criteria moder high psycholog distress particip random assign condit web cbt plus week telephon track web cbt week telephon track neither web cbt telephon track particip assess preintervent postintervent month postinterventionresult postintervent particip complet web intervent either without telephon support lower level hazard alcohol use without track p effect size track p effect size improv qualiti life without track p effect size track p effect size improv cbt literaci without track p effect size track p effect size compar receiv web intervent telephon support result qualiti life cbt literaci maintain month followup differ hazard alcohol use signific differ condit month although omnibus test depress literaci stigma nonsignific contrast reveal webon condit show signific lower level stigma particip control condit postintervent true particip webon web plus track condit month similar webon web plus track condit signific higher depress literaci postintervent maintain webon condit month followup signific differ found depress literaci stigma condit monthsconclus evidencebas web intervent depress can effect reduc depress symptom also improv health outcom includ qualiti life hazard alcohol use knowledg effect strategi depress selfmanagementtri registr intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctn archiv webcit httpwwwwebcitationorgynssh

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