iCBT for depression in diabetes
Unmodified clinician-supported iCBT beat treatment-as-usual on depression, anxiety, distress, and diabetes-specific distress in adults with diabetes.
Source
Web-Based Cognitive Behavior Therapy for Depression in People With Diabetes Mellitus: A Randomized Controlled Trial
Study at a glance
- Design
- RCT — 6-lesson internet CBT vs treatment-as-usual wait for depression in diabetes
- N
- N=106 · 49 iCBT, 57 TAU; 91 with baseline data for ITT analyses
- Population
- Adults with diabetes and depression
- Outcome
- PHQ-9 (and GAD-7 / diabetes distress) at posttreatment
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iCBT for depression in diabetes
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106 individuals were randomized (49 iCBT, 57 TAU)
After phone interview, 106 individuals met the inclusion criteria and were randomized to either iCBT (n=49) or TAU (n=57).
PHQ-9 between-group Hedges g was 0.78
Posttreatment scores were significantly lower in the iCBT group relative to TAU on the PHQ-9, PAID, K-10, GAD-7, and SF-12 mental well-being subscales with moderate between-groups effect sizes on the PHQ-9 ( g =0.78, 95% CI 0.30-1.25), GAD-7 scores ( g =0.72, 95% CI 0.25-1.19), and SF-12 MCS scores ( g =−0.66, 95% CI −1.12 to −0.19).
What they did
After screening, 106 adults with diabetes and depression were randomized to a 6-lesson internet CBT program or treatment-as-usual wait; 91 provided baseline data for ITT analyses. Outcomes included PHQ-9, GAD-7, K-10, PAID, and related measures at posttreatment.
What they found
iCBT produced moderate between-group benefits on PHQ-9 (Hedges g=0.78) and GAD-7 (g=0.72), plus large effects on diabetes distress and general distress. About 66% completed all six lessons; 51% of iCBT completers with data showed reliable PHQ-9 improvement vs 18% of TAU.
The limits
What it doesn't show
Self-reported glycemic control (HbA1c) did not show a clear between-group benefit. Sample sizes shrink at follow-up, and results are for a supported Australian virtual clinic rather than fully unguided public apps.
Key terms
- iCBT
- Internet-delivered cognitive behavior therapy program.
- TAU
- Treatment as usual / wait comparison during the intervention window.
- PAID
- Problem Areas in Diabetes scale for diabetes-specific distress.
- Reliable change
- Individual improvement beyond measurement error on PHQ-9.
- Hedges g
- Bias-adjusted standardized between-group effect size.
- Diabetes mellitus comorbidity
- Depression occurring alongside type 1 or type 2 diabetes.
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What was the experimental treatment?
Common questions
Who was randomized?
106 eligible adults to iCBT (n=49) or TAU (n=57).
Did anxiety improve vs TAU?
Yes—GAD-7 between-group g≈0.72.
Did depression improve vs TAU?
Yes—PHQ-9 between-group g≈0.78.
Was the program diabetes-tailored?
No—authors emphasize an unmodified depression iCBT program.
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