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BackgroundComputerised cognitive–behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression.AimsTo determine the clinical effectiveness of online, unsupported CCBT for depression in primary care.MethodThree hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period.ResultsNo significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses.ConclusionsOnline, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.

Major depression is a common mental health problem in the general population 1 and is associated with substantial reductions in quality of life.2,3 Cost-of-illness studies reveal that the economic burden of depression is considerable. 4 However, many people with depression attending primary care do not receive the care they need. There is little evidence about the effectiveness of pharmacotherapy in patients with mild to moderate depression 5 and psychological treatments in primary care are scarce and costly. Consequently, effective treatments like cognitive-behavioural therapy (CBT) 6,7 are not offered to all patients and many people with depression in primary care remain untreated. 8 An effective, acceptable and feasible solution for such individuals might be computerised CBT (CCBT). 9 The National Institute for Health and Clinical Excellence (NICE) recommended the use of two CCBT software programs for depression and anxiety, 10 and these programs are now in use in England, Wales and Northern Ireland. In the Netherlands, an online CCBT program is currently being used as part of an ongoing implementation study (www.kleurjeleven.nl/). However, evidence about the costeffectiveness of CCBT is still limited.9 To our knowledge, only one study conducted an economic evaluation of CCBT for depression and it showed that CCBT (delivered on a personal computer in the general practice) can be highly cost-effective compared with usual care by a general practitioner (GP) in the UK setting.11 In a recent study, we compared the clinical effectiveness of unsupported, online CCBT (i.e. Colour Your Life) with treatment as usual (TAU) by a GP and a combination of both CCBT and TAU for depression (CCBT plus TAU). 12 In the present study, we assess the cost-effectiveness of these interventions, focusing on the research question: for mild to moderate depression, is CCBT compared with TAU or CCBT plus TAU preferable in terms of cost-effectiveness from a societal perspective? The Medical and Ethical Committee approved the study protocol. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236) Method Design and participantsIn a randomised trial, 303 participants were recruited from the general population by means of a large-scale internet-based screening in the South of the Netherlands. Inclusion criteria were: age 18-65; access to the internet at home (for optimal use of the CCBT program, a broad-band connection was required and not dial-up connection); at least mild to moderate depressive complaints (Beck Depression Inventory II (BDI-II) 13 score516); duration of depressive complaints 3 months or more; no current psychological treatment for depression; no continuous antidepressant treatment for at least 3 months prior to entry; fluent in Dutch language; no alcohol and/ or drug dependence; and no severe psychiatric comorbidity (e.g. psychotic disorders). During a 1-year follow-up period, participants were asked to fill in monthly internet questionnaires. 12,14 InterventionsComputeri...