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Randomized trial of Internet-based relapse prevention for partially remitted depression
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-9500-7763
Örebro University, School of Law, Psychology and Social Work.
Örebro University, School of Law, Psychology and Social Work.
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0002-9688-5805
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2011 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, no 4, p. 285-294Article in journal (Refereed) Published
Abstract [en]

Objective:

To investigate whether Internet-based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment.

Method:

Seventy-one women and 13 men (N= 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet-based CBT or to a control group. Self-help material was used in combination with e-mail contact with a personal therapist. Monthly self-ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later.

Results:

Significantly fewer participants in the CBT group experienced relapse (4⁄38 or 10.5%) compared with those in the control group (14⁄37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post-treatment in the participants who received CBT compared with controls. Reduction in depressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow-up.

Conclusion:

Internet-based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011. Vol. 124, no 4, p. 285-294
Keywords [en]
Depression, Internet, Relapse prevention
National Category
Psychiatry
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-16408DOI: 10.1111/j.1600-0447.2011.01698.xISI: 000294872900006PubMedID: 21401534Scopus ID: 2-s2.0-80052803455OAI: oai:DiVA.org:oru-16408DiVA, id: diva2:432089
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2018-05-03Bibliographically approved
In thesis
1. Managing depression via the Internet: self-report measures, treatment & relapse prevention
Open this publication in new window or tab >>Managing depression via the Internet: self-report measures, treatment & relapse prevention
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cognitive behaviour therapy (CBT) is an effective treatment for depression but access is limited. One way of increasing access is to offer CBT via the Internet. In Study I, guided Internet-based CBT was found to have a large effect on depressive symptoms compared to taking part in an online discussion group. Approximately two hours were spent on guiding each patient and the large effect found differs from previous studies that showed smaller effects, probably due to lack of guidance. The intervention had no effect on the participants’ quality of life but significantly decreased their level of anxiety.

Internet-based versions of self-report measures can be more practical and efficient than paper versions. However, before implementation, evidence of psychometrical equivalence to the paper versions should be available. This was tested in Studies II and III for the Montgomery-Åsberg Depression Rating Scale – Self-rated (MADRS-S) and the Beck Depression Inventory – Second Edition (BDI-II). When the full scales were investigated, equivalent psychometric properties were found in the two versions of the MADRS-S and BDI-II. However, in the Internet-version of the BDI-II, a lower score was found for the question about suicidality and the difference was statistically significant. Although the difference was small, this indicates that suicidality might be underestimated when using the Internet-based BDI-II.

As the long-term prognosis after treatment for depression is poor, in Study IV we investigated the possibility of delivering CBT-based relapse prevention via the Internet. The results revealed that fewer participants in the intervention group experienced a relapse compared to the control group and that the time spent on guiding each participant was approximately 2.5 hours. A trend towards a higher remission rate was found in the CBT group at the six-month follow-up and a reduction of depressive symptoms was associated with a lowered risk of relapse. CBT-based relapse prevention via the Internet can potentially be made available to large numbers of patients, thus improving their prognosis.

The Internet increases the possibilities for health care providers in the management of depression.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2011. p. 88
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 56
Keywords
Internet, depression, cognitive behaviour therapy, self-report measures, relapse prevention
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-15734 (URN)978-91-7668-806-9 (ISBN)
Public defence
2011-09-23, Örebro universitet, Prismahuset, Hörsal P2, Fakultetsgatan 1, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2017-10-17Bibliographically approved

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Holländare, FredrikTillfors, MariaEngström, Ingemar

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