An Internet-Based Intervention for Depression in Primary Care in Spain: A Randomized Controlled Trial

Abstract

BackgroundDepression is the most prevalent cause of illness-induced disability worldwide. Face-to-face psychotherapeutic interventions for depression can be challenging, so there is a need for other alternatives that allow these interventions to be offered. One feasible alternative is Internet-based psychological interventions. This is the first randomized controlled trial (RCT) on the effectiveness of an Internet-based intervention on depression in primary health care in Spain.ObjectiveOur aim was to compare the effectiveness of a low-intensity therapist-guided (LITG) Internet-based program and a completely self-guided (CSG) Internet-based program with improved treatment as usual (iTAU) care for depression.MethodsMulticenter, three-arm, parallel, RCT design, carried out between November 2012 and January 2014, with a follow-up of 15 months. In total, 296 adults from primary care settings in four Spanish regions, with mild or moderate major depression, were randomized to LITG (n=96), CSG (n=98), or iTAU (n=102). Research completers at follow-up were 63.5%. The intervention was Smiling is Fun, an Internet program based on cognitive behavioral therapy. All patients received iTAU by their general practitioners. Moreover, LITG received Smiling is Fun and the possibility of psychotherapeutic support on request by email, whereas CSG received only Smiling is Fun. The main outcome was the Beck Depression Inventory-II at 3 months from baseline. Mixed-effects multilevel analysis for repeated measures were undertaken.ResultsThere was no benefit for either CSG [(B coefficient=-1.15; P=.444)] or LITG [(B=-0.71; P=.634)] compared to iTAU, at 3 months. There were differences at 6 months [iTAU vs CSG (B=-4.22; P=.007); iTAU vs LITG (B=-4.34; P=.005)] and 15 months [iTAU vs CSG (B=-5.10; P=.001); iTAU vs LITG (B=-4.62; P=.002)]. There were no differences between CSG and LITG at any time. Adjusted and intention-to-treat models confirmed these findings.ConclusionsAn Internet-based intervention for depression combined with iTAU conferred a benefit over iTAU alone in the Spanish primary health care system.Trial RegistrationClinicaltrials.gov NCT01611818; https://register.clinicaltrials.gov/prs/app/action/SelectProtocol? selectaction=Edit&uid=U0001NPQ&ts=2&cx=gctdh2&sid=S0003KJ6 (Archived by WebCite at http://www.webcitation.org/6jbsUvUDz)

Variation in chemokines plasma concentrations in primary care depressed patients associated with Internet-based cognitive-behavioral therapy

“…As expected, depression scores decreased significantly after the iCBT intervention, similar to the findings in the randomized clinical trial conducted with this intervention 30 . In addition, chemokine concentrations significantly decreased after the iCBT intervention, even showing large effect sizes.…”

“…The psychological intervention used in this study was the internet-delivered self-help program "Smiling is fun. " This program has been developed 29 for the treatment of depressed primary-care patients among the Spanish population, and its efficacy 30 , cost-effectiveness and cost-utility 31 have been established. "Smiling is fun" consists of 10 web-delivered sequential modules with different CBT-based techniques for coping with mild and moderate depression.…”

Positive and Negative Affect Schedule (PANAS): psychometric properties of the online Spanish version in a clinical sample with emotional disorders

“…The literature presents considerable evidence about the efficacy of Internet-based interventions for emotional disorders [73,74]. Recently in our country, studies have been carried out that also guarantee their efficacy [75][76][77], and so it is important to have validated online assessment tools that can be used to assess PA and NA (two core symptoms) in research and clinical settings. In this regard, the present study provides empirical evidence about the usefulness of the instrument in distinguishing between PA and NA with a digital version of the questionnaire.…”

Internet-Delivered Cognitive Behaviour Therapy

“…Many trials incorporated follow-up to 6-or 12-months post-treatment [13][14][15], demonstrating that iCBT has the potential to achieve and maintain significant clinical gains for service users. A smaller number have shown lasting impacts up to 3-years post-treatment [16,17].…”