Depression treatment
Can short online self-help courses reduce depression?
Open access · cc by · source: Europe PMC
Two guided online self-help courses, one based on CBT and a shorter one based on problem solving, both reduced depressive symptoms more than waiting, with medium-sized effects and no clear winner between them.
Study at a glance
- Design
- RCT — Three-arm RCT with computer-generated block randomisation: 8-week internet CBT, 5-week internet problem-solving therapy (PST), or waiting list; both active arms had weekly email support from trained psychology students; outcomes at 5, 8 and 12 weeks analysed by intention to treat with linear mixed models.
- N
- N=263 · 263 adults randomised across the three arms; attrition from follow-up questionnaires reached 43% by 12 weeks and was handled by mixed-model estimation.
- Population
- Self-referred Dutch-speaking adults recruited via newspaper and web advertisements, scoring 16 or more on the CES-D depression scale; mostly women and highly educated.
- Outcome
- Depressive symptoms on the CES-D (primary); anxiety (HADS subscale) and quality of life (EQ-5D) as secondary outcomes; clinically significant change.
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Key findings
Both courses beat the waiting list on depression by 8 and 12 weeks, and problem-solving therapy was already ahead at 5 weeks; the two courses did not differ from each other. At 12 weeks the between-group effect sizes for depression were d = 0.69 for CBT and 0.65 for problem solving, and 34 CBT and 30 problem-solving participants showed clinically significant improvement versus none on the waiting list. Anxiety and quality of life also improved more in the treatment groups, though quality-of-life effects were small.
Methodology
Adults with elevated depressive symptoms who answered newspaper and web adverts were randomly assigned to an 8-lesson internet CBT course, a 5-week internet problem-solving therapy course, or a waiting list. Both courses came with brief weekly email feedback from trained master's students that encouraged people to keep going but did not give therapy. Depression, anxiety and quality of life were measured online at 5, 8 and 12 weeks.
Limitations
Dropout from the follow-up questionnaires was high and was greater in the treatment arms than on the waiting list, so results depend on statistical estimation of missing data. Only about 38% of people completed all lessons, participants were self-referred, mostly women and highly educated, and none had a clinical diagnostic interview, so the findings may not apply to clinical or less-educated populations. There was no blinding, the comparison was a waiting list rather than an active control, and follow-up lasted only 12 weeks.
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