Computerized cognitive behavior therapy for patients with mild to moderately severe depression in primary care: A pragmatic cluster randomized controlled trial (@ktiv)
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Computerized cognitive behavior therapy for patients with mild to moderately severe depression in primary care: A pragmatic cluster randomized controlled trial (@ktiv). / Löbner, Margrit; Pabst, Alexander; Stein, Janine; Dorow, Marie; Matschinger, Herbert; Luppa, Melanie; Maroß, Astrid; Kersting, Anette; König, Hans-Helmut; Riedel-Heller, Steffi G.
in: J AFFECT DISORDERS, Jahrgang 238, 01.10.2018, S. 317-326.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Computerized cognitive behavior therapy for patients with mild to moderately severe depression in primary care: A pragmatic cluster randomized controlled trial (@ktiv)
AU - Löbner, Margrit
AU - Pabst, Alexander
AU - Stein, Janine
AU - Dorow, Marie
AU - Matschinger, Herbert
AU - Luppa, Melanie
AU - Maroß, Astrid
AU - Kersting, Anette
AU - König, Hans-Helmut
AU - Riedel-Heller, Steffi G
N1 - Copyright © 2018 Elsevier B.V. All rights reserved.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - BACKGROUND: Self-guided computerized cognitive behavior therapy (cCBT) has the potential to be a feasible alternative to current first-step treatment approaches for depression. Yet, research regarding the effectiveness and acceptability of self-guided cCBT as an adjunct element of GP care is controversial.METHODS: Primary care patients with symptoms of mild to moderately severe depression (N = 647) were recruited from 112 GP practices within a cluster randomized controlled trial. GPs were randomized to groups that provided either cCBT (internet intervention) plus treatment as usual (TAU) or TAU alone. Primary outcomes were self-reported depression severity according to the Beck Depression Inventory (BDI-II) and Patient Health Questionnaire (PHQ-9). Intention to treat (ITT) and per protocol (PP) analysis was performed.RESULTS: ITT analyses showed significant between group differences in depressive symptoms for BDI-II in favor of the intervention group, corresponding to a small effect size (6 weeks: d = 0.36, 95% CI 0.19 to 0.53, P < .001; 6 months: d = 0.41, 95% 0.22 to 0.59, P < .001). The number needed to treat (NNT) at six months was 6.2. PHQ-9 analyses was solely significant at six months (d = 0.26, 95% CI 0.08 to 0.44, P < .05, NNT = 9.2). PP analyses highly agree with these findings.LIMITATIONS: The initial response rate with regard to the recruitment of GP practices for the trial was low.CONCLUSIONS: The results suggest that cCBT is effective in reducing depressive symptoms in mildly to moderately severe depressed primary care patients. Efforts should be made to raise awareness about the potential of such freely accessible treatment options among GPs and patients.
AB - BACKGROUND: Self-guided computerized cognitive behavior therapy (cCBT) has the potential to be a feasible alternative to current first-step treatment approaches for depression. Yet, research regarding the effectiveness and acceptability of self-guided cCBT as an adjunct element of GP care is controversial.METHODS: Primary care patients with symptoms of mild to moderately severe depression (N = 647) were recruited from 112 GP practices within a cluster randomized controlled trial. GPs were randomized to groups that provided either cCBT (internet intervention) plus treatment as usual (TAU) or TAU alone. Primary outcomes were self-reported depression severity according to the Beck Depression Inventory (BDI-II) and Patient Health Questionnaire (PHQ-9). Intention to treat (ITT) and per protocol (PP) analysis was performed.RESULTS: ITT analyses showed significant between group differences in depressive symptoms for BDI-II in favor of the intervention group, corresponding to a small effect size (6 weeks: d = 0.36, 95% CI 0.19 to 0.53, P < .001; 6 months: d = 0.41, 95% 0.22 to 0.59, P < .001). The number needed to treat (NNT) at six months was 6.2. PHQ-9 analyses was solely significant at six months (d = 0.26, 95% CI 0.08 to 0.44, P < .05, NNT = 9.2). PP analyses highly agree with these findings.LIMITATIONS: The initial response rate with regard to the recruitment of GP practices for the trial was low.CONCLUSIONS: The results suggest that cCBT is effective in reducing depressive symptoms in mildly to moderately severe depressed primary care patients. Efforts should be made to raise awareness about the potential of such freely accessible treatment options among GPs and patients.
KW - Journal Article
U2 - 10.1016/j.jad.2018.06.008
DO - 10.1016/j.jad.2018.06.008
M3 - SCORING: Journal article
C2 - 29902736
VL - 238
SP - 317
EP - 326
JO - J AFFECT DISORDERS
JF - J AFFECT DISORDERS
SN - 0165-0327
ER -
