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BMC Psychiatry
Published in: BMC Psychiatry 1/2013

Open Access 01-12-2013 | Study protocol

Internet-based treatment of major depression for patients on a waiting list for inpatient psychotherapy: protocol for a multi-centre randomised controlled trial

Authors: Jo Annika Reins, David Daniel Ebert, Dirk Lehr, Heleen Riper, Pim Cuijpers, Matthias Berking

Published in: BMC Psychiatry | Issue 1/2013

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Abstract

Background

Major depressive disorder (MDD) is a prevalent and severe disorder. Although effective treatments for MDD are available, many patients remain untreated, mainly because of insufficient treatment capacities in the health care system. Resulting waiting periods are often associated with prolonged suffering and impairment as well as a higher risk of chronification. Web-based interventions may help to alleviate these problems. Numerous studies provided evidence for the efficacy of web-based interventions for depression. The aim of this study is to evaluate a new web-based guided self-help intervention (GET.ON-Mood Enhancer-WL) specifically developed for patients waiting to commence inpatient therapy for MDD.

Methods

In a two-armed randomised controlled trial (n = 200), the web-based guided intervention GET.ON-Mood Enhancer-WL in addition to treatment as usual (TAU) will be compared with TAU alone. The intervention contains six modules (psycho education, behavioural activation I & II, problem solving I & II, and preparation for subsequent inpatient depression therapy). The participants will be supported by an e-coach, who will provide written feedback after each module. Inclusion criteria include a diagnosis of MDD assessed with a structured clinical interview [SCID] and a waiting period of at least three weeks before start of inpatient treatment. The primary outcome is observer-rated depressive symptom severity (HRSD24). Further (explorative) questions include whether remission will be achieved earlier and by more patients during inpatient therapy because of the web-based preparatory intervention.

Discussion

If GET.ON-Mood Enhancer-WL is proven to be effective, patients may start inpatient therapy with reduced depressive symptom severity, ideally leading to higher remission rates, shortened inpatient therapy, reduced costs, and decreased waiting times.

Trial registration

German Clinical Trial Registration (DRKS): DRKS00004708.
Appendix
Available only for authorised users
Literature
1.
Kessler RC: Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity survey replication. Arch Gen Psychiatry. 2005, 62: 593-10.1001/archpsyc.62.6.593.CrossRefPubMed
2.
Alonso J, Angermeyer M, Lépine J: The European study of the epidemiology of mental disorders (ESEMeD) project: an epidemiological basis for informing mental health policies in Europe. Acta Psychiatr Scand. 2004, 109: 5-7. 10.1111/j.1600-0047.2004.00325.x.CrossRef
3.
Waraich P, Goldner EM, Somers JM, Hsu L: Prevalence and incidence studies of mood disorders: a systematic review of the literature. Can J Psychiatry. 2004, 49: 124-138.PubMed
4.
Ansseau M, Dierick M, Buntinkx F, Cnockaert P, De Smedt J, van Den Haute M, Vander Mijnsbrugge D: High prevalence of mental disorders in primary care. J Affect Disord. 2004, 78: 49-55. 10.1016/S0165-0327(02)00219-7.CrossRefPubMed
5.
Briley M, Lépine : The increasing burden of depression. NDT. 2011, 7: 3-7.CrossRef
6.
7.
Rapaport MH, Clary C, Fayyad R, Endicott J: Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatr. 2005, 162: 1171-1178. 10.1176/appi.ajp.162.6.1171.CrossRefPubMed
8.
Ebmeier K, Donaghey C, Steele JD: Recent developments and current controversies in depression. Lancet. 2006, 367: 153-167. 10.1016/S0140-6736(06)67964-6.CrossRefPubMed
9.
Luppa M, Heinrich S, Angermeyer MC, König H, Riedel-Heller SG: Cost-of-illness studies of depression. J Affect Disord. 2007, 98: 29-43. 10.1016/j.jad.2006.07.017.CrossRefPubMed
10.
Vittengl JR, Clark LA, Dunn TW, Jarrett RB: Reducing relapse and recurrence in unipolar depression: a comparative meta-analysis of cognitive-behavioral therapy’s effects. J Consult Clin Psychol. 2007, 75: 475-488.CrossRefPubMedPubMedCentral
11.
Eaton WW: Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry. 2008, 65: 513-10.1001/archpsyc.65.5.513.CrossRefPubMedPubMedCentral
12.
Cuijpers P, Smit F: Excess mortality in depression: a meta-analysis of community studies. J Affect Disord. 2002, 72: 227-236. 10.1016/S0165-0327(01)00413-X.CrossRefPubMed
13.
Spijker J, Bijl RV, De Graaf R, Nolen WA: Care utilization and outcome of DSM-III-R major depression in the general population: results from the Netherlands mental health survey and incidence study (NEMESIS). Acta Psychiatr Scand. 2001, 104: 19-24. 10.1034/j.1600-0447.2001.00363.x.CrossRefPubMed
14.
Andrews G, Titov N: Depression is very disabling. Lancet. 2007, 370: 808-809. 10.1016/S0140-6736(07)61393-2.CrossRefPubMed
15.
Smit F, Cuijpers P, Oostenbrink J, Batelaan N, De Graaf R, Beekman A: Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ. 2006, 9: 193-200.PubMed
16.
Wang PS, Simon G, Kessler RC: The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatr Res. 2003, 12: 22-33. 10.1002/mpr.139.CrossRefPubMed
17.
Cuijpers P, Van Straten A, Andersson G, Van Oppen P: Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008, 76: 909-922.CrossRefPubMed
18.
Cuijpers P, Van Straten A, Warmerdam L, Andersson G: Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry. 2008, 8: 36-10.1186/1471-244X-8-36.CrossRefPubMedPubMedCentral
19.
Bebbington P, Brugha T, Meltzer H, Jenkins R, Ceresa C, Farrell M, Lewis G: Neurotic disorders and the receipt of psychiatric treatment. Int Rev Psychiatry. 2003, 15: 108-114. 10.1080/0954026021000046010.CrossRefPubMed
20.
Kessler RC, Berglund PA, Bruce ML, Koch RJ, Laska EM, Leaf PJ, Manderscheid RW, Rosenheck RA, Walters EE, Wang PS: The prevalence and correlates of untreated serious mental illness. Health Serv Res. 2001, 36: 987-1007.PubMedPubMedCentral
21.
Moritz S, Schröder J, Meyer B, Hauschildt M: The more is needed, the less is wanted: attitudes toward face-to-face intervention among depressed patients undergoing online treatment. Depress Anxiety. 2013, 30: 157-167. 10.1002/da.21988.CrossRefPubMed
22.
Schulz H, Barghaan D, Harfst T, Koch U: Psychotherapeutische Versorgung. 2008, Berlin: Gesundheitsberichterstattung des Bundes
23.
Helbig S, Hähnel A, Weigel B, Hoyer J: Wartezeit für Psychotherapiepatienten–und wie sie zu nutzen ist: Waiting time in psychotherapy–and how to make use of it. Verhaltenstherapie. 2004, 14: 294-302. 10.1159/000082839.CrossRef
24.
Barkham M, Mullin T, Leach C, Stiles WB, Lucock M: Stability of the CORE-OM and the BDI-I prior to therapy: evidence from routine practice. Psychol Psychother Theory Res Pract. 2007, 80: 269-278. 10.1348/147608306X148048.CrossRef
25.
Taylor DJ, Walters HM, Vittengl JR, Krebaum S, Jarrett RB: Which depressive symptoms remain after response to cognitive therapy of depression and predict relapse and recurrence?. J Affect Disord. 2010, 123: 181-187. 10.1016/j.jad.2009.08.007.CrossRefPubMed
26.
Bockting CL, Spinhoven P, Koeter MWJ, Wouters LF, Schene AH, for the Depression Evaluation Longitudinal Therapy Assessment (DELTA) Study Group: Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability for depression: a 2-year prospective study. J Clin Psychiatry. 2006, 67: 747-755. 10.4088/JCP.v67n0508.CrossRefPubMed
27.
Vittengl JR, Clark LA, Jarrett RB: Moderators of continuation phase cognitive therapy’s effects on relapse, recurrence, remission, and recovery from depression. Behav Res Ther. 2010, 48: 449-458. 10.1016/j.brat.2010.01.006.CrossRefPubMedPubMedCentral
28.
29.
Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V: Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007, 37: 319-328. 10.1017/S0033291706008944.CrossRefPubMed
30.
Gregory RJ, Schwer Canning S, Lee TW, Wise JC: Cognitive bibliotherapy for depression: a meta-analysis. Prof Psychol: Res Pract. 2004, 35: 275-280.CrossRef
31.
McKendree-Smith NL, Floyd M, Scogin FR: Self-administered treatments for depression: a review. J Clin Psychol. 2003, 59: 275-288. 10.1002/jclp.10129.CrossRefPubMed
32.
Kok RN, Van Straten A, Beekman ATF, Bosmans JE, De Neef M, Cuijpers P: Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial. BMC Psychiatry. 2012, 12: 131-10.1186/1471-244X-12-131.CrossRefPubMedPubMedCentral
33.
Lin J, Ebert D, Lehr D, Berking M, Baumeister H: Internet based cognitive behavioral interventions: state of the art and implementation possibilities in rehabilitation: article in German. Rehabilitation. 2013, 52: 155-163.CrossRefPubMed
34.
Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N, Baune BT: Computer therapy for the anxiety and depressive disorders is effective acceptable and practical health care: a meta-analysis. PLoS ONE. 2010, 5: e13196-10.1371/journal.pone.0013196.CrossRefPubMedPubMedCentral
35.
Andersson G, Cuijpers P: Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009, 38: 196-205. 10.1080/16506070903318960.CrossRefPubMed
36.
Ebert D, Tarnowski T, Gollwitzer M, Sieland B, Berking M: A transdiagnostic internet-based maintenance treatment enhances the stability of outcome after inpatient cognitive behavioral therapy: a randomized controlled trial. Psychother Psychosom. 2013, 82: 246-256. 10.1159/000345967.CrossRefPubMed
37.
Ebert DD, Gollwitzer M, Sieland B, Berking M: Who profits from a Transdiagnostic Internet-based maintenance Treatment? Who does not? Moderators of Outcome from a Randomized Controlled Trial. In press
38.
Andersson G: Using the internet to provide cognitive behaviour therapy. Behav Res Ther. 2009, 47: 175-180. 10.1016/j.brat.2009.01.010.CrossRefPubMed
39.
Cuijpers P, Marks IM, Van Straten A, Cavanagh K, Gega L, Andersson G: Computer‒aided psychotherapy for anxiety disorders: a meta‒analytic review. Cogn Behav Ther. 2009, 38: 66-82. 10.1080/16506070802694776.CrossRefPubMed
40.
Kenter R, Warmerdam L, Brouwer-Dudokdewit C, Cuijpers P, Van Straten A: Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects. BMC Psychiatry. 2013, 13: 43-10.1186/1471-244X-13-43.CrossRefPubMedPubMedCentral
41.
Ruwaard J, Schrieken B, Schrijver M, Broeksteeg J, Dekker J, Vermeulen H, Lange A: Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cogn Behav Ther. 2009, 38: 206-221. 10.1080/16506070802408086.CrossRefPubMed
42.
Warmerdam L, Van Straten A, Jongsma J, Twisk J, Cuijpers P: Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: exploring mechanisms of change. J Behav Ther Exp Psychiatry. 2010, 41: 64-70. 10.1016/j.jbtep.2009.10.003.CrossRefPubMed
43.
Cuijpers P, Van Straten A, Warmerdam L: Problem solving therapies for depression: a meta-analysis. Eur Psychiatry. 2007, 22: 9-15. 10.1016/j.eurpsy.2006.11.001.CrossRefPubMed
44.
Van Straten A, Cuijpers P, Smits N: Effectiveness of a web-based self-help intervention for symptoms of depression, anxiety, and stress: randomized controlled trial. J Med Internet Res. 2008, 10: e7-10.2196/jmir.954.CrossRefPubMedPubMedCentral
45.
Cuijpers P, Huibers M, Ebert DD, Koole SL, Andersson G: How much psychotherapy is needed to treat depression? A metaregression analysis. J Affect Disord. 2013, 149: 1-13. 10.1016/j.jad.2013.02.030.CrossRefPubMed
46.
Richards D, Richardson T: Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012, 32: 329-342. 10.1016/j.cpr.2012.02.004.CrossRefPubMed
47.
Johansson R, Andersson G: Internet-based psychological treatments for depression. Expert Rev Neurotherapeutics. 2012, 12: 861-870. 10.1586/ern.12.63.CrossRef
48.
Berger T, Hämmerli K, Gubser N, Andersson G, Caspar F: Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cogn Behav Ther. 2011, 40: 251-266. 10.1080/16506073.2011.616531.CrossRefPubMed
49.
Camerini L, Schulz PJ: Effects of functional interactivity on patients’ knowledge, empowerment, and health outcomes: an experimental model-driven evaluation of a web-based intervention. J Med Internet Res. 2012, 14: e105-10.2196/jmir.1953.CrossRefPubMedPubMedCentral
50.
Hurling R, Fairley BW, Dias MB: Internet-based exercise intervention systems: are more interactive designs better?. Psychol Health. 2006, 21: 757-772. 10.1080/14768320600603257.CrossRef
51.
52.
Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R, Thase ME, Kocsis JH, Keller MB: The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Soc Biol Psychiatry. 2003, 54: 573-583. 10.1016/S0006-3223(02)01866-8.CrossRef
53.
Knesevich JW, Biggs JT, Clayton PJ, Ziegler VE: Validity of the Hamilton rating scale for depression. Br J Psychiatry. 1977, 131: 49-52. 10.1192/bjp.131.1.49.CrossRefPubMed
54.
Miller IW, Bishop S, Norman WH, Maddever H: The modified Hamilton rating scale for depression: reliability and validity. Psychiatry Res. 1984, 14: 131-142.CrossRef
55.
Rush AJ, Gullion CM, Basco MR, Jarrett RB, Trivedi MH: The inventory of depressive symptomatology (IDS): psychometric properties. Psychol Med. 1996, 26: 477-10.1017/S0033291700035558.CrossRefPubMed
56.
Trivedi M, Rush A, Ibrahim H, Carmody T, Biggs M, Suppes T, Crismon M, Shores-Wilson K, Toprac M, Dennehy E, Witte B, Kasher T: The inventory of depressive symptomatology, clinician rating (IDS-C) and self-report (IDS-SR), and the quick inventory of depressive symptomatology, clinician rating (QIDS-C) and self-report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological medicine. 2004, 34: 73-82. 10.1017/S0033291703001107.CrossRefPubMed
57.
American Psychiatric Association: Diagnostic and statistical manual of mental disorders IV-TR. 2000, Washington DC: American Psychiatric Association
58.
Kroenke K, Spitzer RL: The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002, 32: 1-7.CrossRef
59.
Kroenke K, Spitzer RL: The PHQ-9 validity of a brief depression severity measure. J Gen Intern Med. 2001, 16: 606-613. 10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentral
60.
The EuroQol Group: EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990, 16: 199-208.CrossRef
61.
von der Graf Schulenburg J, Claes C, Greiner W, Uber A: Die deutsche version des EuroQol-Fragebogens: the German version of the EuroQol questionnaire. Zeitschrift für Gesundheitswissenschaften. 1998, 6: 3-20.
62.
D’Zurilla TJ, Nezu AM: MA: Social Problem-Solving Inventory-Revised (SPSI-R). 2002, New York: MHS
63.
Manos RC, Kanter JW, Luo W: The behavioral activation for depression scale–short form: development and validation. Behav Ther. 2011, 42: 726-739. 10.1016/j.beth.2011.04.004.CrossRefPubMed
64.
Berle D, Starcevic V, Moses K, Hannan A, Milicevic D, Sammut P: Preliminary validation of an ultra-brief version of the Penn State worry questionnaire. Clin Psychol Psychother. 2011, 18: 339-346. 10.1002/cpp.724.CrossRefPubMed
65.
Schulte D: Messung der Therapieerwartung und Therapieevaluation von Patienten (PATHEV): patient questionnaire on therapy expectation and evaluation (PATHEV). Z Klin Psychol Psychother. 2005, 34: 176-187. 10.1026/1616-3443.34.3.176.CrossRef
66.
Bassler M, Potratz B, Krauthauser H: Der “Helping Alliance Questionnaire” (HAQ) von Luborsky: Möglichkeiten zur Evaluation des therapeutischen Prozesses von stationärer Psychotherapie. Psychotherapeut. 1995, 40: 23-32.
67.
Luborsky L, Barber JP, Siqueland L, Johnson S, Najavits LM, Frank A, Daley D: The revised helping alliance questionnaire (HAQ-II): psychometric properties. J Psychother Pract Res. 1996, 5: 260-271.PubMedPubMedCentral
68.
Rush AJ, Kraemer HC, Sackeim HA, Fava M, Trivedi MH, Frank E, Ninan PT, Thase ME, Gelenberg AJ, Kupfer DJ, Regier DA, Rosenbaum JF, Ray O, Schatzberg AF: Report by the ACNP task force on response and remission in major depressive disorder. Neuropsychopharmacology. 2006, 31: 1841-1853. 10.1038/sj.npp.1301131.CrossRefPubMed
69.
Schafer JL, Graham JW: Missing data: our view of the state of the art. Psychol Methods. 2002, 7: 147-177.CrossRefPubMed
70.
Hedeker D, Gibbons RD: Application of random-effects pattern-mixture models for missing data in longitudinal studies. Psychol Methods. 1997, 2: 64-78.CrossRef
71.
Cohen J: Statistical power analysis for the behavioral sciences. 1988, Hillsdale, New York: Erlbaum
72.
Metadata
Title
Internet-based treatment of major depression for patients on a waiting list for inpatient psychotherapy: protocol for a multi-centre randomised controlled trial
Authors
Jo Annika Reins
David Daniel Ebert
Dirk Lehr
Heleen Riper
Pim Cuijpers
Matthias Berking
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2013
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-13-318

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