Guided internet-based intervention for people with HIV and depressive symptoms: a randomised controlled trial in the Netherlands

Luenen, Sanne van; Garnefski, Nadia; Spinhoven, Philip

doi:10.1016/s2352-3018(18)30133-4

Cited by 33 publications

(58 citation statements)

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“…Mobile health (mHealth) has increasingly become a promising tool to deliver treatments for a range of psychosocial disorders [ 1 - 4 ]. Studies have shown that mHealth interventions are effective in reducing depressive symptoms among people living with HIV and elevated depressive symptoms [ 5 - 8 ]. In comparison with traditional face-to-face interventions, mHealth interventions have the potential to implement personalized and cost-effective interventions, provide real-time feedback, and overcome geographical and logistical barriers [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial

Zeng¹,

Guo²,

Li³

et al. 2020

JMIR Mhealth Uhealth

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Background Associations between higher levels of patient engagement and better health outcomes have been found in face-to-face interventions; studies on such associations with mobile health (mHealth) interventions have been limited and the results are inconclusive. Objective The objective of this study is to investigate the relationship between patient engagement in an mHealth intervention and depressive symptoms using repeated measures of both patient engagement and patient outcomes at 4 time points. Methods Data were drawn from a randomized controlled trial (RCT) of an mHealth intervention aimed at reducing depressive symptoms among people living with HIV and elevated depressive symptoms. We examined the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received an adapted cognitive-behavioral stress management (CBSM) course and physical activity promotion on their WeChat social media app. Depressive symptoms were repeatedly measured using the Patient Health Questionnaire (PHQ-9) at baseline and 1 month, 2 months, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of items completed, and time spent on the program at 1 month, 2 months, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points in the intervention. Results The mean PHQ-9 scores were 10.2 (SD 4.5), 7.7 (SD 4.8), 6.5 (SD 4.7), and 6.7 (SD 4.1) at baseline, 1 month, 2 months, and 3 months, respectively. The mean completion rates were 50.6% (SD 31.8%), 51.5% (SD 32.2%), and 50.8% (SD 33.7%) at 1, 2, and 3 months, respectively; the average frequencies of items completed were 18.0 (SD 14.6), 32.6 (SD 24.8), and 47.5 (SD 37.2) at 1, 2, and 3 months, respectively, and the mean times spent on the program were 32.7 (SD 66.7), 65.4 (SD 120.8), and 96.4 (SD 180.4) minutes at 1, 2, and 3 months, respectively. LGCMs showed good model fit and indicated that a higher completion rate (β at 3 months=–2.184, P=.048) and a greater frequency of items completed (β at 3 months=–0.018, P=.04) were associated with fewer depressive symptoms at 3 months. Although not significant, similar trends were found in the abovementioned relationships at 1 and 2 months. There was no significant relationship between time spent on the program and depressive symptoms. Conclusions This study revealed a positive association between patient engagement and health outcomes at 3 months of an mHealth intervention using LGCMs and repeated measures data. The results underscore the importance of improving patient engagement in mHealth interventions to improve patient-centered health outcomes. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://tinyurl.com/yxb64mef International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5693-1

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Section: Introductionmentioning

confidence: 99%

Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial

Zeng¹,

Guo²,

Li³

et al. 2020

JMIR Mhealth Uhealth

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“…Though, it was previously found that the intervention was effective in decreasing depressive symptoms, compared to the control group (25).…”

Section: Discussionmentioning

confidence: 88%

“…In conclusion, this study investigated the cost-utility of a guided Internet intervention for PLWH with depressive symptoms, compared to attention only. It was previously found that the intervention was effective in decreasing depressive symptoms compared to the control group (25).…”

Section: Discussionmentioning

confidence: 92%

“…In 2015, we have developed an Internet-based CBT intervention for PLWH with depressive symptoms: Living positive with HIV (24). In a randomized controlled trial (RCT), we have found that the intervention including telephone coaching was effective in reducing depressive symptoms, compared to a control condition that received attention only and was put on a waiting list (25). The aim of the current study was to evaluate the cost-utility of the intervention, compared to attention only.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Participants suffered from moderate depressive symptoms at baseline (PHQ-9 score: M = 11.44, SD = 4.50). More information regarding baseline characteristics of the sample can be found elsewhere(25).…”

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confidence: 99%

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Cost-utility of a guided Internet-based intervention in comparison with attention only for people with HIV and depressive symptoms: A randomized controlled trial

Luenen

Garnefski

Spinhoven

et al. 2019

Journal of Psychosomatic Research

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Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression

Terhorst,

Kaiser,

Brakemeier

et al. 2024

JAMA Netw Open

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ImportanceWhile the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary.ObjectiveTo investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness.Data SourcesA systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials.Study SelectionTitles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted.Main Outcomes and MeasuresHeterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs.ResultsThe systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire–9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = −0.02; 95% credible interval [CrI], −0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = −0.56; 95% CrI, −0.46 to −0.66). An interaction effect between guidance and baseline severity was found (β̂ = −0.24, 95% CrI, −0.03 to −0.46).Conclusions and RelevanceIn this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.

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Guided internet-based intervention for people with HIV and depressive symptoms: a randomised controlled trial in the Netherlands

Abstract: Aids Fonds.

Cited by 33 publications

References 34 publications

Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial

Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial

Cost-utility of a guided Internet-based intervention in comparison with attention only for people with HIV and depressive symptoms: A randomized controlled trial

Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression

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