Article Text
Abstract
Objective This study aims to examine whether the effects of internet interventions for depression generalise to participants recruited in clinical settings.
Design This study uses subgroup analysis of the results of a randomised, controlled, single-blind trial.
Setting The study takes place in five diagnostic centres in Germany.
Participants A total of 1013 people with mild to moderate depressive symptoms were recruited from clinical sources as well as internet forums, statutory insurance companies and other sources.
Interventions This study uses either care-as-usual alone (control) or a 12-week internet intervention (Deprexis) plus usual care (intervention).
Main outcome measures The primary outcome measure was self-rated depression severity (Patient Health Questionnaire-9) at 3 months and 6 months. Further measures ranged from demographic and clinical parameters to a measure of attitudes towards internet interventions (Attitudes towards Psychological Online Interventions Questionnaire).
Results The recruitment source was only associated with very few of the examined demographic and clinical characteristics. Compared with participants recruited from clinical sources, participants recruited through insurance companies were more likely to be employed. Clinically recruited participants were as severely affected as those from other recruitment sources but more sceptical of internet interventions. The effectiveness of the intervention was not differentially associated with recruitment source (treatment by recruitment source interaction=0.28, p=0.84).
Conclusion Our results support the hypothesis that the intervention we studied is effective across different recruitment sources including clinical settings.
Trial registration number ClinicalTrials.gov NCT01636752.
- internet intervention
- cognitive behaviour therapy
- depression
- randomized controlled trial
- recruitment source.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors The principal investigators (TB, FH, JPK, BM and SM) designed the study and obtained funding. The EVIDENT study steering committee (TB, JPK, BM, SM, CS and JS) further developed the study design in collaboration with the EVIDENT study group (steering committee and Wolfgang Greiner, Bielefeld; MH; WL; and Matthias Rose, Berlin) and CG. Patient recruitment was coordinated by the EVIDENT study group. JPK conducted the statistical analyses with substantial input from EV. The results were interpreted by the steering committee with substantial input from the study group and CG. JPK wrote the manuscript with substantial input from the steering committee and CG. All authors commented on the manuscript and approved the final version.
Competing interests JPK received funding for clinical trials (German Federal Ministry of Health, Servier - distributor of the internet intervention “Deprexis"), payments for presentations on internet interventions (Servier) and payments for workshops and books (Beltz, Elsevier and Hogrefe) on psychotherapy for chronic depression and on psychiatric emergencies. BM is employed as research director at GAIA AG, the company that developed, owns and operates the internet intervention “Deprexis”. MH is a consultant of Servier. He was an invited speaker at several workshops and continuous education workshops over the last two years. All the other authors report no relationships with commercial interests.
Ethics approval German Psychological Association (DGPs SM 04_2012)
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Individual participant data that underlie the results reported in this article can be shared with researchers who provide a methodologically sound proposal to the steering committee. Proposals may be submitted up to 36 months following article publication.