Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial

Abstract

BackgroundDepression is a high prevalence disorder, displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. In Ireland 12-month prevalence of depression has been reported to be 10.3%. A large percentage of affected individuals have no medical diagnosis nor seek treatment. Cognitive Behavior Therapy (CBT) has established itself as an option for the treatment of depression. Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult.Stepped-care can increase access to evidence-based CBT. One option is tailored internet-delivered treatment programs. Preliminary research from Ireland needs now to include large-scale studies on effectiveness. Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample.Method/DesignThe study is a randomized controlled trial of an online CBT (iCBT) program for the treatment of adults with depressive symptoms. The trial will include an active treatment group and a waiting-list control group. The active condition will consist of 8 weekly modules of iCBT, with post-session feedback support. Participants in the waiting list will receive access to the treatment at week 8. Participants will complete the Beck Depression Inventory (BDI-II) and eligibility criteria will also apply. Primary outcomes are depressive symptoms. Secondary outcomes include quality of life indicators, significant events and satisfaction with online treatment. Data will be collected at baseline and at post-treatment, week 8, and at follow-up week 20 (3-months) and week 32 (6-months). Analysis will be conducted on the intention-to-treat basis.DiscussionThe study seeks to evaluate the effectiveness of an online delivered treatment for depression in a community sample of Irish adults with symptoms of depression. The study will be a first contribution and depending on the sample recruited the results may be generalizable to people with similar difficulties in Ireland and may therefore give insight into the potential of low-intensity interventions for Irish people with depressive symptoms.Trial registration numberCurrent Controlled Trials ISRCTN03704676. DOI: 10.1186/ISRCTN03704676

A secondary analysis of internet-delivered cognitive-behaviour treatment for adults with severe depressive symptoms (Preprint)

“…Effect size was calculated as per the RCT protocol [26]. Reliable change and deterioration were calculated based on a movement of 9 or more points on the BDI-II from pre to post treatment measurement [30].…”

“…Thereafter the BDI-II, GAD-7, and WSAS were completed at the end of treatment, week 8, and at 3-month followup. A complete description of the measures can be found in the trial protocol [26].…”

“…Progressing implementation of internet-delivered interventions with severely depressed cohorts has been much slower than in mild to moderately depressed groups, particularly because of the increase risk of suicide associated with this population [25]. Research evaluating internet-delivered interventions often exclude suicidal ideation as an ethical consideration and so, their effects of reducing suicidal ideation and ultimately risk of suicide are not well documented [26,27]. While the literature may not be conclusive, some of the research suggests that internet-delivered interventions may have similar benefits for individuals with greater severity of depressive symptoms as for those with mild to moderate symptoms.…”

“…For the current trial, the programme was delivered in a supported format and participants in the trial received brief asynchronous feedback based on their progress through the iCBT programme each week for a period of 8 weeks. A detailed description of the modules is provided in Table 2 and it can be also found in the protocol [26].…”

“…Participants in this secondary analysis consisted of a subsample from a larger Randomised Controlled Trial (RCT) [26,27]. The larger RCT recruited participants who were within the mild to moderate symptom severity as determined by a score of between 14 and 28 on the Beck Depression Inventory (BDI-II).…”