An Internet-based program for depressive symptoms using human and automated support: a randomized controlled trial

Adriana Mira, Juana Bretón-López, Azucena García-Palacios, Soledad Quero, Rosa María Baños, Cristina Botella, Adriana Mira, Juana Bretón-López, Azucena García-Palacios, Soledad Quero, Rosa María Baños, Cristina Botella

Abstract

Purpose: The purpose of this study was to analyze the efficacy of an Internet-based program for depressive symptoms using automated support by information and communication technologies (ICTs) and human support.

Patients and methods: An Internet-based program was used to teach adaptive ways to cope with depressive symptoms and daily problems. A total of 124 participants who were experiencing at least one stressful event that caused interference in their lives, many of whom had clinically significant depressive symptoms, were randomly assigned into either an intervention group with ICT support (automated mobile phone messages, automated emails, and continued feedback through the program); an intervention group with ICT support plus human support (brief weekly support phone call without clinical content); or a waiting-list control. At pre-, post-, and 12-month follow-up, they completed depression, anxiety, positive and negative effect, and perceived stress measures. Results were analyzed using both intention-to-treat and completers data. The majority were women (67.7%), with a mean age of 35.6 years (standard deviation =9.7).

Results: The analysis showed that the two intervention groups improved significantly pre- to posttreatment, compared with the control group. Furthermore, improvements were maintained at the 12-month follow-up. Adherence and satisfaction with the program was high in both conditions.

Conclusion: The Internet-based program was effective and well accepted, with and without human support, showing that ICT-based automated support may be useful. It is essential to continue to study other ICT strategies for providing support.

Keywords: adherence; depressive symptomatology; online intervention; satisfaction; types of support.

Conflict of interest statement

Disclosure There has been no financial support for this work that could have influenced its outcome. The authors confirm that the manuscript has been read and approved by all named authors and that the order of authors listed in the manuscript has been approved by all of them. They also confirm that this research has not been published previously and that it is not under consideration for publication elsewhere. On behalf of all coauthors, the corresponding author shall bear full responsibility for the submission. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Structured protocol for the type of support provided to participants. Abbreviation: ICT, information and communication technology.
Figure 2
Figure 2
Flowchart of study. Abbreviations: IG, intervention group; IGHS, intervention group with human support; WL, waiting list control condition.

References

    1. Haro J, Ayuso-Mateos J, Bitter I, et al. ROAMER: roadmap for mental health research in Europe. Int J Methods Psychiatr Res. 2013;23(S1):1–14.
    1. Mitchell A, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet. 2009;374(9690):609–619.
    1. Ferrari A, Charlson F, Norman R, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10(11):e1001547.
    1. Andrews G. Should depression be managed as a chronic disease? BMJ. 2001;322(7283):419–421.
    1. Kessler R, Merikangas K, Wang P. Prevalence, comorbidity, and service utilization for mood disorders in the United States at the beginning of the twenty-first century. Annu Rev Clin Psychol. 2007;3(1):137–158.
    1. Cuijpers P, Beekman A, Reynolds C. Preventing depression. JAMA. 2012;307(10):1033.
    1. Bentley K, Gallagher M, Carl J, Barlow D. Development and validation of the Overall Depression Severity and Impairment Scale. Psychol Assess. 2014;26(3):815–830.
    1. Barlow D, Allen L, Choate M. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205–230.
    1. Botella C, Moragrega I, Baños R, García-Palacios A. Online predictive tools for intervention in mental illness: the OPTIMI project. In: Westwood JD, editor. Medicine Meets Virtual Reality. Amsterdam: IOS Press; 2011. pp. 86–92.
    1. Kinderman P, Schwannauer M, Pontin E, Tai S. Psychological processes mediate the impact of familial risk, social circumstances and life events on mental health. PLoS One. 2013;8(10):e76564.
    1. World Health Organization (WHO) Prevention of mental disorders: effective interventions and policy options: summary report/a report of the World Health Organization Dept. of Mental Health and Substance Abuse; in collaboration with the Prevention Research Centre of the Universities of Nijmegen and Maastricht. Geneva: 2004.
    1. European Pact for Mental Health and Wellbeing; EU high level conference. Together for metal health and wellbeing; Brussels. 2008.
    1. Nathan PE, Gorman JM. A Guide to Treatments that Work. 3rd ed. New York: Oxford University Press; 2007.
    1. Cuijpers P, van Straten A, Andersson G, van Oppen P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008;76(6):909–922.
    1. Cuijpers P, Reynolds C, Donker T, Li J, Andersson G, Beekman A. Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review. Depress Anxiety. 2012;29(10):855–864.
    1. Kazdin A, Blase S. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect Psychol Sci. 2011;6(1):21–37.
    1. Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H. Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry Suppl. 2004;184(6):526–533.
    1. Titov N. Internet-delivered psychotherapy for depression in adults. Curr Opin Psychiatry. 2011;24(1):18–23.
    1. Kazdin A, Rabbitt S. Novel models for delivering mental health services and reducing the burdens of mental illness. Clin Psychol Sci. 2013;1(2):170–191.
    1. Cuijpers P, Donker T, Johansson R, Mohr D, van Straten A, Andersson G. Self-guided psychological treatment for depressive symptoms: a meta-analysis. PLoS One. 2011;6(6):e21274.
    1. Andersson G. Internet-delivered psychological treatments. Annu Rev Clin Psychol. 2016;12(1):157–179.
    1. Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2006;37(03):319.
    1. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):329–342.
    1. Kaltenthaler E, Parry G, Beverley C, Ferriter M. Computerised cognitive-behavioural therapy for depression: systematic review. Br J Psychiatry. 2008;193(3):181–184.
    1. NICE – National Institute for Health and Clinical Excellence . Depression in adults: the treatment and management of depression in adults – NICE Guidelines. London: 2009.
    1. Andrews G, Cuijpers P, Craske M, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010;5(10):e13196.
    1. Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clin Child Fam Psychol Rev. 2010;13(3):275–290.
    1. Melville K, Casey L, Kavanagh D. Dropout from Internet-based treatment for psychological disorders. Br J Clin Psychol. 2010;49(4):455–471.
    1. Andersson G. Using the Internet to provide cognitive behaviour therapy. Behav Res Ther. 2009;47(3):175–180.
    1. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196–205.
    1. Karyotaki E, Kleiboer A, Smit F, et al. Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘individual patient data’ meta-analysis. Psychol Med. 2015;45(13):2717–2726.
    1. Newman M, Szkodny L, Llera S, Przeworski A. A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy? Clin Psychol Rev. 2011;31(1):89–103.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSMIV-TR) Washington (DC): American Psychiatric Association; 2000.
    1. Berger T, Hämmerli K, Gubser N, Andersson G, Caspar F. Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cogn Behav Ther. 2011;40(4):251–266.
    1. Botella C, Mira A, Moragrega I, et al. An Internet-based program for depression using activity and physiological sensors: efficacy, expectations, satisfaction, and ease of use. NDT. 2016;12:393–406.
    1. Lejuez C, Hopko D, Hopko S. A brief behavioral activation treatment for depression: treatment manual. Behav Modif. 2001;25(2):255–286.
    1. Seligman M, Csikszentmihalyi M. Positive psychology: an introduction. Am Psychol. 2000;55(1):5–14.
    1. Sin N, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. J Clin Psychol. 2009;65(5):467–487.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.
    1. Lecrubier Y, Sheehan D, Weiller E, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12(5):224–231.
    1. Ferrando L, Franco L, Soto M, et al. MINI. MINI International Neuropsychiatric Interview. Versión en español 5.0.0. Madrid: Instituto IAP; 1998.
    1. Christensen H, Mackinnon A, Batterham P, et al. The effectiveness of an online e-health application compared to attention placebo or sertraline in the treatment of generalised anxiety disorder. Internet Interv. 2014;1(4):169–174.
    1. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio (TX): Psychological Corp; 1996.
    1. Storch E, Roberti J, Roth D. Factor structure, concurrent validity, and internal consistency of the beck depression inventory? Second edition in a sample of college students. Depress Anxiety. 2004;19(3):187–189.
    1. Sanz J, García Vera MP, Espinosa R, et al. Adaptación española del inventario para la depresión de Beck-II (BDI-II): 3. Propiedades psicométricas en pacientes con trastornos psicológicos. Clínica y Salud. 2005;16:121–142.
    1. Norman S, Hami Cissell S, Means-Christensen A, Stein M. Development and validation of an Overall Anxiety Severity and Impairment Scale (OASIS) Depress Anxiety. 2006;23(4):245–249.
    1. Mira A, González A, Botella C, et al. TÍTULO: psychometric properties of the Overall Anxiety Severity and Impairment Scale in Spanish sample. Clinical and general populations; Poster presented at: 49th Annual ABCT Convention; November 12–15, 2015; Chicago.
    1. González-Robles A, Mira A, Riera López del Amo A, et al. Psychometric properties of the Overall Depression Severity and Impairment Scale in Spanish sample. General and clinical populations; Poster presented at: European Society for Research on Internet Interventions (ESRII) Conference; September 17–18; Poland.
    1. Watson D, Clark L, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–1070.
    1. Sandín B, Chorot P, Lostao L, et al. Escalas Panas de afecto positivo y negativo: Validación factorial y transcultural. Psicothema. 1999;11:37–51.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385.
    1. Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The Social Psychology of Health. Newbury Park: Sage; 1988. pp. 31–67.
    1. Lee E. Erratum to review of the psychometric evidence of the Perceived Stress Scale. Asian Nurs Res. 2013;7(3):160.
    1. Campo A, Bustos G, Romero A. Consistencia interna y dimensionalidad de la Escala de estrés percibido (EEP-10 y EEP-14) en una muestra de universitarias de Bogotá, Colombia. Aquichan. 2009;9:271–280.
    1. Borkovec TD, Nau SD. Credibility of analogue therapy rationales. J Behav Ther Exp Psychiatry. 1972;3(4):257–260.
    1. Botella C, Gallego MJ, Garcia-Palacios A, Baños RM, Quero S, Alcañiz M. The acceptability of an Internet-based self-help treatment for fear of public speaking. Br J Guid Counc. 2009;37(3):297–311.
    1. Quero S, Pérez-Ara M, Bretón-López J, García-Palacios A, Baños R, Botella C. Acceptability of virtual reality interoceptive exposure for the treatment of panic disorder with agoraphobia. Br J Guid Counc. 2013;42(2):123–137.
    1. Leykin Y, Muñoz R, Contreras O, Latham M. Results from a trial of an unsupported internet intervention for depressive symptoms. Internet Interv. 2014;1(4):175–181.
    1. Crawford J, Henry J. The positive and negative affect schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample. Br J Clin Psychol. 2004;43(3):245–265.
    1. Johansson R, Andersson G. Internet-based psychological treatments for depression. Expert Rev Neurother. 2012;12(7):861–870.
    1. Clarke G, Eubanks D, Reid E, et al. Overcoming depression on the internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders. J Med Internet Res. 2005;7(2):e16.
    1. Farrer L, Christensen H, Griffiths K, Mackinnon A. Internet-based CBT for depression with and without telephone tracking in a national helpline: randomised controlled trial. PLoS One. 2011;6(11):e28099.
    1. Kelders S, Bohlmeijer E, Pots W, van Gemert-Pijnen J. Comparing human and automated support for depression: fractional factorial randomized controlled trial. Behav Res Ther. 2015;72:72–80.
    1. Kleiboer A, Donker T, Seekles W, van Straten A, Riper H, Cuijpers P. A randomized controlled trial on the role of support in Internet-based problem solving therapy for depression and anxiety. Behav Res Ther. 2015;72:63–71.
    1. Wootton B, Dear B, Johnston L, Terides M, Titov N. Remote treatment of obsessive-compulsive disorder: a randomized controlled trial. J Obsessive Compuls Relat Disord. 2013;2(4):375–384.
    1. Emmelkamp P, David D, Beckers T, et al. Advancing psychotherapy and evidence-based psychological interventions. Int J Methods Psychiatr Res. 2013;23(S1):58–91.
    1. Andersson G. Internet-based self-help for depression: randomised controlled trial. Br J Psychiatry Suppl. 2005;187(5):456–461.
    1. Stallard P, Richardson T, Velleman S, Attwood M. Computerized CBT (think, feel, do) for depression and anxiety in children and adolescents: outcomes and feedback from a pilot randomized controlled trial. Behav Cogn Psychother. 2011;39(03):273–284.
    1. Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K. Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One. 2010;5(6):e10939.

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