Objectives To investigate early effects of the COVID-19 pandemic related to 1) levels of worry, risk perception, and social distancing; 2) longitudinal effects on wellbeing; and 3) effects of worry, risk perception, and social distancing on wellbeing. Methods We analyzed annual changes in four aspects of wellbeing over five years (2015–2020): life satisfaction, financial satisfaction, self-rated health, and loneliness in a subsample (n=1071, aged 60–71) from a larger survey of Swedish older adults. The 2020 wave, collected March 26–April 2, included measures of worry, risk perception, and social distancing in response to COVID-19. Results 1) In relation to COVID-19: 44.9% worried about health, 69.5% about societal consequences, 25.1% about financial consequences; 86.4% perceived a high societal risk, 42.3% a high risk of infection, and 71.2% reported high levels of social distancing. 2) Wellbeing remained stable (life satisfaction and loneliness) or even increased (self-rated health and financial satisfaction) in 2020 compared to previous years. 3) More worry about health and financial consequences was related to lower scores in all four wellbeing measures. Higher societal worry and more social distancing were related to higher wellbeing. Discussion In the early stage of the pandemic, Swedish older adults on average rated their wellbeing as high as, or even higher than, previous years. However, those who worried more reported lower wellbeing. Our findings speak to the resilience, but also heterogeneity, among older adults during the pandemic. Further research, on a broad range of health factors and long-term psychological consequences, is needed.

Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.

No abstract

ObjectiveThe objective of this study was to explore primary care patients’ experiences of Internet mediated cognitive behavioural therapy (iCBT) depression treatment.DesignQualitative study. Data were collected from focus group discussions and individual interviews.SettingPrimary care.MethodData were analysed by systematic text condensation by Malterud.SubjectsThirteen patients having received iCBT for depression within the PRIM-NET study.Main outcome measuresAnalysis presented different aspects of patients’ experiences of iCBT.ResultsThe informants described a need for face-to-face meetings with a therapist. A therapist who performed check-ups and supported the iCBT process seemed important. iCBT implies that a responsibility for the treatment is taken by the patient, and some patients felt left alone, while others felt well and secure. This was a way to work in privacy and freedom with a smoothly working technology although there was a lack of confidence and a feeling of risk regarding iCBT.ConclusioniCBT is an attractive alternative to some patients with depression in primary care, but not to all. An individual treatment design seems to be preferred, and elements of iCBT could be included as a complement when treating depression in primary care. Such a procedure could relieve the overall treatment burden of depression.Key pointsInternet mediated cognitive behavioural therapy (iCBT) can be effective in treating depression in primary care, but patients’ experiences of iCBT are rarely studied Most patients express a need for human contact, real-time interaction, dialogue and guidance when treated for depression.The patient’s opportunity to influence the practical circumstances about iCBT is a success factor, though this freedom brings a large responsibility upon the receiver.An individual treatment design seems to be crucial, and elements of iCBT could be included as a complement to face-to-face meetings.

Depression presents a serious condition for the individual and a major challenge to health care and society. Internet-based cognitive behavior therapy (ICBT) is a treatment option supported in several trials, but there is as yet a lack of effective studies of ICBT in “real world” primary care settings. We examined whether ICBT differed from treatment-as-usual (TAU) in reducing depressive symptoms after 3 months. TAU comprised of visits to general practitioner, registered nurse, antidepressant drugs, waiting list for, or psychotherapy, or combinations of these alternatives. Patients, aged ≥ 18 years, who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview. A total of 90 patients were randomized to either TAU or ICBT. The ICBT treatment included interactive elements online, a workbook, a CD with mindfulness and acceptance exercises, and minimal therapist contact. The treatment period lasted for 12 weeks after which both groups were assessed. The main outcome measure was Beck Depression Inventory-II (BDI-II). Additional measures were Montgomery Åsberg Depression Rating Scale – self rating version (MADRS-S) and Beck Anxiety Inventory (BAI). The analyses revealed no significant difference between the two groups at post treatment, neither on BDI-II, MADRS-S, nor BAI. Twenty patients (56%) in the ICBT treatment completed all seven modules. Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness, after 3 months, is at par with TAU.