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Effectiveness of a novel integrative online treatment for depression (Deprexis): Randomized controlled trial
University Medical Center Hamburg-Eppendorf.
University of Berne.
University of Berne.
University of Texas.
Show others and affiliations
2009 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, Vol. 11, no 2, e15- p.Article in journal (Refereed) Published
Abstract [en]

Background: Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training. Objective: To evaluate the effectiveness of the Web-based intervention in a randomized controlled trial. Methods: There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Completer analyses and intention-to-treat analyses were performed. Results: Of 396 participants, 216 (55%) completed the post-measurement 9 weeks later. Available case analyses revealed a significant reduction in depression severity (BDI), Cohens d = .64 (CI 95% = 0.33 - 0.94), and significant improvement in social functioning (WSA), Cohens d = .64, 95% (CI 95% = 0.33 - 0.95). These improvements were maintained at 6-month follow-up. Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements (BDI: Cohens d = .30, CI 95% = 0.05 - 0.55; WSA: Cohens d = .36, CI 95% = 0.10 - 0.61). Moreover, a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms (BDI: odds ratio [OR] = 6.8, CI 95% = 2.90 - 18.19) and recovered more often (OR = 17.3, 95% CI 2.3 - 130). More than 80% of the users felt subjectively that the program had been helpful. Conclusions: This integrative, Web-based intervention was effective in reducing symptoms of depression and in improving social functioning. Findings suggest that the program could serve as an adjunctive or stand-alone treatment tool for patients suffering from symptoms of depression. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 64953693; http://www.controlled-trials.com/ISRCTN64953693/64953693 (Archived by WebCite at http://www.webcitation.org/5ggzvTJPD)

Place, publisher, year, edition, pages
2009. Vol. 11, no 2, e15- p.
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Medical and Health Sciences
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URN: urn:nbn:se:liu:diva-21543DOI: 10.2196/jmir.1151OAI: oai:DiVA.org:liu-21543DiVA: diva2:241496
Available from: 2009-10-03 Created: 2009-10-02 Last updated: 2014-11-28

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Andersson, Gerhard

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