- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT02190968
Reducing Residual Depressive Symptoms With Web-based Mindful Mood Balance
Reducing Residual Depressive Symptoms With Web-based Mindful Mood Balance.
Studieöversikt
Status
Intervention / Behandling
Detaljerad beskrivning
Residual depressive symptoms (RDS) following remission of major depressive disorder (MDD) are reported by 80-90% of adults receiving first-line antidepressant pharmacotherapy and carry an elevated risk for a chronic course of illness, rapid relapse and functional impairment. Strategies for managing residual symptoms, however, have met with mixed success. Mindful Mood Balance (MMB; R34 MH0877223) is an individually tailored, web-based treatment designed to train remitted depressed patients to disengage from dysphoria-activated depressogenic thinking that perpetuates RDS and increases risk for relapse/recurrence. MMB was developed to increase access to Mindfulness-Based Cognitive Therapy (MBCT; R01 MH066992), an empirically supported prophylactic group treatment that can be easily sequenced with acute phase antidepressant pharmacotherapy. Results from our open trial of MMB (N=100) showed an effect size of d=1.09 for pre to post treatment reductions in depression scores among patients with RDS and d=1.54 in a quasi-experimental comparison to patients receiving usual care, with an on average reduction of 1.98 points on the PHQ-9 for MMB patients. The investigators now propose a pragmatic randomized clinical trial of MMB to evaluate its effectiveness in reducing RDS in recurrently depressed patients. Patients will be members of Kaiser-Permanente Colorado (N = 460), aged 18 to 75, who score >5 and <9 on the PHQ-9, in remission from MDD and will be randomized 1:1 to either the usual depression care pathway (DepCare) or Mindful Mood Balance (MMB)+DepCare.
The investigators plan to test whether patients receiving MMB+DepCare will show greater reductions in RDS at both 8 week and 12 months follow up, than those receiving DepCare alone. The investigators are also interested in examining whether fewer patients in MMB+DepCare will relapse over the follow up and will have higher end state functioning and quality of life. In order to examine the costs associated with adding this online treatment to the Depression Care Pathways at KPCO, the investigators will calculate the marginal costs per additional number of depression free days (DFDs) for patients. Resolution of RDS can reduce the enormous personal and social costs experienced by Americans with this persistent symptom burden.
Studietyp
Inskrivning (Faktisk)
Fas
- Inte tillämpbar
Kontakter och platser
Studieorter
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Colorado
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Denver, Colorado, Förenta staterna, 80237-8066
- Kaiser Permanente Institute for Health Research
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Patients with a PHQ-9 score between 5 and 9
- At least one prior episode of MDD
Exclusion Criteria:
- presence of schizophrenia or current psychosis, organic mental disorder or pervasive developmental delay
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Dubbel
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Experimentell: Mindful Mood Balance
An 8 session internet intervention targeting residual depressive symptoms.
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Usual Depression Care will be based on the Kaiser Permanente Adult Depression National Guidelines - an adaptation of STAR*D (Rush et al., 2006) for antidepressant management and the IMPACT (Unitzer et al., 2002; 2008) model for therapy.
Mindful Mood Balance is an individually tailored, web-based version of Mindfulness-Based Cognitive Therapy, a manualized, group skills training program (Segal et al., 2002) that is based on an integration of aspects of cognitive therapy for depression (Beck, 1979) with components of the mindfulness-based stress reduction program (Kabat-Zinn, 1990).
Patients participated in 8 internet sessions, each of which incorporates didactic and experiential learning, along with home practice of skills taught in the program.
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Aktiv komparator: Usual Depression Care
Usual Depression Care through Kaiser Permanente Colorado
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Usual Depression Care will be based on the Kaiser Permanente Adult Depression National Guidelines - an adaptation of STAR*D (Rush et al., 2006) for antidepressant management and the IMPACT (Unitzer et al., 2002; 2008) model for therapy.
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Patient Health Questionnaire-9
Tidsram: Change from Baseline to 12 weeks and 15 months
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Changes in self reported depressive symptom severity
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Change from Baseline to 12 weeks and 15 months
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Patient Health Questionnaire-9
Tidsram: Between 12 weeks and 15 months
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Rates of depressive relapse, defined as patients who score 15 or greater on the PHQ-9
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Between 12 weeks and 15 months
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Patient Health Questionnaire-9
Tidsram: Between baseline to 12 weeks.
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Conversion from moderate/high risk to low risk symptom categories, defined as a patient whose PHQ-9 score drops from a baseline PHQ-9 score between 5 and 9 to a mean score of 4 or less
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Between baseline to 12 weeks.
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Ruminative Responses Scale
Tidsram: Change from Baseline to 6 weeks, 12 weeks and 15 months
|
A self-report measure of rumination
|
Change from Baseline to 6 weeks, 12 weeks and 15 months
|
Five Facet Mindfulness Questionnaire
Tidsram: Change from Baseline to 6 weeks, 12 weeks and 15 months
|
Self report measure of mindful awareness
|
Change from Baseline to 6 weeks, 12 weeks and 15 months
|
Five Facet Mindfulness Scale
Tidsram: Change from Baseline to 6 weeks, 12 weeks and 15 months
|
Self report measure of mindful awareness
|
Change from Baseline to 6 weeks, 12 weeks and 15 months
|
Experiences Questionnaire
Tidsram: Change from Baseline to 6 weeks, 12 weeks and 15 months
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Self report measure of decentering/wider awareness
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Change from Baseline to 6 weeks, 12 weeks and 15 months
|
Andra resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Depression Free Days
Tidsram: Change from Baseline to 12 weeks and 15 months
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Self report of days free of depression
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Change from Baseline to 12 weeks and 15 months
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Generalized Anxiety Disorder Assessment - 7
Tidsram: Change from Baseline to 12 weeks and 15 months
|
Self report measure of generalized anxiety
|
Change from Baseline to 12 weeks and 15 months
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Short Form Health Survey - 12
Tidsram: Change from Baseline to 12 weeks and 15 months
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Self report measure of physical and mental health
|
Change from Baseline to 12 weeks and 15 months
|
Emotion Dot Probe Task
Tidsram: Change from Baseline to 12 weeks and 15 months
|
A behavioural measure of attentional bias
|
Change from Baseline to 12 weeks and 15 months
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Samarbetspartners och utredare
Sponsor
Utredare
- Huvudutredare: Zindel V Segal, PhD, University of Toronto
Publikationer och användbara länkar
Allmänna publikationer
- Boggs JM, Beck A, Felder JN, Dimidjian S, Metcalf CA, Segal ZV. Web-based intervention in mindfulness meditation for reducing residual depressive symptoms and relapse prophylaxis: a qualitative study. J Med Internet Res. 2014 Mar 24;16(3):e87. doi: 10.2196/jmir.3129.
- Segal ZV, Bieling P, Young T, MacQueen G, Cooke R, Martin L, Bloch R, Levitan RD. Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Arch Gen Psychiatry. 2010 Dec;67(12):1256-64. doi: 10.1001/archgenpsychiatry.2010.168.
- Dimidjian S, Beck A, Felder JN, Boggs JM, Gallop R, Segal ZV. Web-based Mindfulness-based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther. 2014 Dec;63:83-9. doi: 10.1016/j.brat.2014.09.004. Epub 2014 Sep 18.
- Boggs JM, Ritzwoller DP, Beck A, Dimidjian S, Segal ZV. Cost-Effectiveness of a Web-Based Program for Residual Depressive Symptoms: Mindful Mood Balance. Psychiatr Serv. 2022 Feb 1;73(2):158-164. doi: 10.1176/appi.ps.202000419. Epub 2021 Jul 29.
- Segal ZV, Dimidjian S, Beck A, Boggs JM, Vanderkruik R, Metcalf CA, Gallop R, Felder JN, Levy J. Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms: A Randomized Clinical Trial. JAMA Psychiatry. 2020 Jun 1;77(6):563-573. doi: 10.1001/jamapsychiatry.2019.4693. Erratum In: JAMA Psychiatry. 2020 May 1;77(5):545.
Användbara länkar
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- R01MH102229-01A1 (U.S.S. NIH-anslag/kontrakt)
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National Taiwan University HospitalDepartment of HealthAvslutadClimacteric symptom | Värmevallningar och/eller svettningar
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Kaohsiung Veterans General Hospital.AvslutadBarrett Esophagus | Återflöde | Protonpumpshämmare | Symptom
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Universidad Rey Juan CarlosMinisterio de Economía y Competitividad, SpainAvslutadStress, Fysiologisk | Depressiva symtom | Oroliga symptom | SkuldSpanien
Kliniska prövningar på Usual Depression Care
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University of Massachusetts, WorcesterCenters for Disease Control and PreventionAvslutad
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Sun Yat-Sen Memorial Hospital of Sun Yat-Sen UniversityAktiv, inte rekryterandeDepression | Kognitiv försämring | Åldersrelaterad hörselnedsättningKina
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Albert Einstein College of MedicineColumbia University; University of Rochester; Rutgers UniversityAvslutadPediatrisk fetma | Karies i tidig barndomFörenta staterna
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Yale UniversityRekrytering
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University of PennsylvaniaNational Cancer Institute (NCI); American Cancer Society, Inc.AvslutadFibros | Huvud- och halscancer | LymfödemFörenta staterna
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VA Office of Research and DevelopmentAvslutadPTSD | Posttraumatisk stressyndromFörenta staterna
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Florida State UniversityUniversity of South Florida; Colorado Business Group on HealthAvslutad
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Ohio State UniversityHar inte rekryterat ännuPostpartum depression | Postpartum ångest | Kardiometaboliskt syndromFörenta staterna
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Karolinska InstitutetAktiv, inte rekryterandeBarnmisshandel | BarnmisshandelSverige
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Ludwig-Maximilians - University of MunichProf. OTTO Beisheim Stiftung (Germany)AvslutadDepressiv sjukdom | Depression i tonårenTyskland