Web-Based Cognitive Behavior Therapy for Depression in People With Diabetes Mellitus: A Randomized Controlled Trial

Abstract

BackgroundDepression is twice as common in diabetes mellitus (DM) as the general population and is associated with adverse health outcomes, but access to evidence-based therapies such as cognitive behavioral therapy (CBT) is limited in routine diabetes care. Past research has shown that generic Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for depression in the general population, but it has never been evaluated in people with comorbid depression and DM.ObjectiveThe aim of our study was to examine the efficacy of a generic 6-lesson iCBT delivered over 10 weeks in people with major depressive disorder (MDD) and DM.MethodsParticipants with comorbid MDD and DM (type 1 or 2) were recruited online and randomized to an iCBT program with therapist support provided by phone and email (n=42) or a treatment as usual (TAU, n=49) control group. Outcomes were assessed through Web-based self-report questionnaires and the trial was Web-based with no face-to-face components. Primary outcomes were self-reported depression (patient health questionnaire-9, PHQ-9), diabetes-related distress (problem areas in diabetes, PAID), and self-reported glycemic control (hemoglobin A1c, HbA1c). Secondary outcomes were general distress (Kessler 10-item psychological distress scale, K-10) and disability (short form 12-item, SF-12), generalized anxiety (generalized anxiety disorder 7-item, GAD-7), and somatization (PHQ-15). The iCBT group was assessed at 3 months.ResultsA total of 27 participants (66%; 27/41) completed the iCBT program. Analyses indicated between-group superiority of iCBT over TAU at posttreatment on PHQ-9 (g=0.78), PAID (g=0.80), K-10 (g=1.06), GAD-7 (g=0.72), and SF-12 mental well-being scores (g=0.66), but no significant differences in self-reported HbA1c levels (g=0.14), SF-12 physical well-being, or PHQ-15 scores (g=0.03-0.21). Gains were maintained at 3-month follow-up in the iCBT group, and the 87% (27/31) of iCBT participants who were interviewed no longer met criteria for MDD. Clinically significant change following iCBT on PHQ-9 scores was 51% (21/41) versus 18% (9/49) in TAU.ConclusionsiCBT for depression is an efficacious, accessible treatment option for people with diabetes. Future studies should explore whether tailoring of iCBT programs improves acceptability and adherence, and evaluate the long-term outcomes following iCBT.Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ACTRN): 12613001198718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365208&isReview=true (Archived by WebCite at http://www.webcitation.org/6qCR8Fi9V)

Web-Based Interventions for Depression in Individuals with Diabetes: Review and Discussion (Preprint)

“…According to these criteria, a total of five studies were identified [21,[30][31][32][33]. A summary of the reviewed articles is provided in Table 1.…”

“…Three studies had waitlist as control [21,30,31], one added daily emotion reporting [31]. One study used treatment as usual as control [33]. In Nobis and cols study [32], the control group had access to an unguided online brief psychoeducation program for depression.…”

“…Two studies included follow-up, one in one month [21] and the other in three months (for the intervention group only, as the control group received the intervention after they completed the posttreatment assessment) [33]. See Table 1 for posttreatment assessment and follow-up by study.…”

“…However, for intervention efficacy and cost-effectiveness, there's the need to address if the effects are long lasting. One option is to conduct withingroup analyses like Newby and cols [33] did.…”

“…All studies included standardized measures to assess symptoms of depression: the Center for Epidemiological Studies-Depression (CES-D) measure [21,[30][31][32] or the Patient Health Questionnaire-9 (PHQ-9) [33]. Questionnaires were administered online, at baseline, posttreatment and at follow-up (when present).…”