Economic Evaluation of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms

Background Cognitive behavioral therapy (CBT) is frequently used to treat depressive symptoms in people living with HIV. We developed an internet-based cognitive behavioral intervention for people with HIV and depressive symptoms, which was based on an effective self-help booklet. The Web-based intervention was previously found to be effective. Objective The objective of this study was to investigate potential mediators of the Web-based intervention. Methods This study was part of a randomized controlled trial, in which the intervention was compared with an attention-only waiting list control condition. Participants were 188 (97 in intervention group and 91 in control group) people with HIV and mild to moderate depressive symptoms recruited in HIV treatment centers in the Netherlands. A total of 22 participants (22/188, 11.7%) in the study were female and 166 (166/188, 88.3%) were male. The average age of the participants was 46.30 years (SD 10.63). The intervention comprised Web-based self-help CBT for 8 weeks, 1 to 2 hours a week, including minimal telephone support from a coach. The participants received Web-based questionnaires at pretest, 3 times during the intervention/or waiting period, and post intervention. The outcome was depressive symptoms. Factors tested as potential mediators were changes in behavioral activation, relaxation, the cognitive coping strategies catastrophizing and positive refocusing, goal re-engagement, and coping self-efficacy. Results Using multilevel structural equation modeling, changes in behavioral activation (P=.006) and goal re-engagement (P=.009) were found to be significant mediators of the intervention effect. The mediation effect seemed to occur between weeks 3 and 5 for behavioral activation and weeks 1 and 3 for goal re-engagement. Using (bivariate) autoregressive latent trajectory analysis, we found a return effect (from the dependent variable to the mediator) for goal re-engagement but not for behavioral activation, which suggested that the mediation effect of changes in behavioral activation was stronger than that in goal re-engagement. Conclusions The results suggest that changes in behavioral activation and goal re-engagement may mediate the effect of the Web-based intervention for people with HIV and depressive symptoms. The results may lead to possible mechanisms of change of the intervention and improvement of therapy outcomes. Clinical Trial Netherlands Trial Register NTR5407; https://www.trialregister.nl/trial/5298

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Optimizing the Context of Support to Improve Outcomes of Internet-Based Self-help in Individuals With Depressive Symptoms: Protocol for a Randomized Factorial Trial (Preprint)

10.2196/preprints.21207 ◽

2020 ◽

Author(s):

Oliver Thomas Bur ◽

Tobias Krieger ◽

Steffen Moritz ◽

Jan Philipp Klein ◽

Thomas Berger

Keyword(s):

Depressive Symptoms ◽

Problem Solving ◽

Health Care Systems ◽

Routine Care ◽

Diagnostic Interview ◽

Problem Solving Therapy ◽

Web Based ◽

Specific Content ◽

Problem Solving Skills ◽

Self Help

BACKGROUND Internet-based self-help interventions for individuals with depressive symptoms, in which the main component is often a web-based self-help program, have been shown to be efficacious in many controlled trials. However, there are also trials on self-help programs showing no significant effect when delivered in routine care, and some studies report high dropout and low adherence rates. Research suggests that these findings do not emerge primarily due to the specific content of a self-help program. It seems more important how a program is embedded in the context of human and automated support before and during the use of a self-help program. OBJECTIVE This study aims to better understand the effects of 4 supportive contextual factors on outcomes of and adherence to a web-based self-help program for depressive symptoms. In a factorial experiment, 2 of 4 supportive factors, for which there is evidence for their role on outcomes and adherence, are realized during the intervention—personal guidance and automated email reminders. The other 2 factors are realized before the intervention—a diagnostic interview and a preintervention module aimed at increasing the motivation to use the program with motivational interviewing techniques. METHODS The study is a full factorial randomized trial. Adults with mild to moderate depressive symptoms (Patient Health Questionnaire–9 score: 5-14) are recruited from the community through the internet and conventional media. All participants receive access to a web-based self-help program based on problem-solving therapy. They are randomized across 4 experimental factors, each reflecting the presence versus absence of a supportive factor (guidance, automated reminders, diagnostic interview, preintervention module) resulting in a 16-condition balanced factorial design. The primary outcome is depressive symptoms at 10 weeks post assessment. Secondary outcomes include adherence to the program, anxiety, stress, health-related quality of life, possible negative effects, and treatment satisfaction. Potential moderators and mediators (eg, treatment expectancy, problem-solving skills, working alliance with the study team) will also be investigated. RESULTS Ethical approval was received on January 20, 2020. The study was initiated in February 2020, and 240 participants have been enrolled in the study as of November 1, 2020. Recruitment for a total of 255 participants is ongoing. Data collection is expected to be completed by May 2021. CONCLUSIONS A better understanding of relevant supportive factors in the dissemination of web-based interventions is necessary to improve outcomes of and adherence to web-based self-help programs. This study may inform health care systems and guide decisions to optimize the implementation context of web-based self-help programs for depressive symptoms. CLINICALTRIAL ClinicalTrials.gov NCT04318236; https://clinicaltrials.gov/ct2/show/NCT04318236 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/21207

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Happy@work: Effectiveness of a preventive web-based guided self-help course for employees with depressive symptoms

PsycEXTRA Dataset ◽

10.1037/e577572014-003 ◽

2013 ◽

Cited By ~ 1

Author(s):

Anna Geraedts ◽

Noortje Wiezer ◽

Annet Kleiboer ◽

Pim Cuijpers ◽

Willem van Mechelen

Keyword(s):

Depressive Symptoms ◽

Web Based ◽

Work Effectiveness ◽

Self Help

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Complaint-Directed Mini-Interventions for Depressive Symptoms: A Health-Economic Evaluation of Unguided Web-Based Self-Help Interventions (Preprint)

10.2196/preprints.10455 ◽

2018 ◽

Author(s):

Ben F.M. Wijnen ◽

Suzanne Lokman ◽

Stephanie Leone ◽

Silvia M.A.A. Evers ◽

Filip Smit

Keyword(s):

Health Economic ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Depressive Symptomatology ◽

Health Economic Evaluation ◽

Control Group ◽

Web Based ◽

Self Help ◽

Low Threshold

BACKGROUND The past decades depression prevention and early intervention has become a top priority within the Netherlands, however, there is still considerable room for improvement. To this extent, web-based complaint-directed mini-interventions (CDMIs) were developed. These brief and low-threshold interventions focus on psychological stress, sleep problems, and worry, because these complaints are highly prevalent, are demonstrably associated with depression and have a substantial economic impact. OBJECTIVE Aim of the current economic evaluation is to examine the added value of web-based unguided self-help CDMIs as compared to a wait-listed control group with unrestricted access to usual care both from a societal and healthcare perspective. METHODS This health economic evaluation was embedded in a randomized controlled trial. The study entailed two-arms in which three web-based CMDIs were compared to a no-intervention waiting-list control group (control group received intervention at three months follow-up). Measurements were conducted at baseline, and at three- and six-months follow-up. Primary outcome of the study was response rate on depressive symptomatology as measured by the Inventory of Depressive Symptomatology Self-Report (IDS-SR). Change in quality of life was estimated by calculating effect sizes (Cohens’ d) for individual pre- and post-treatment IDS-SR scores. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstraps (5000 times) of seemingly unrelated regression equations and cost-effectiveness acceptability curves were constructed for the costs per QALY gained. RESULTS In total, 329 participants were included in the study of which 165 randomized to the CDMI group. At three months follow-up the responder rate was 13.9% in the CDMI group and 7.3% in the control group. Participants in the CDMI group gained 0.15 QALY at three months follow-up compared to baseline, whereas participants in the control group gained 0.03 QALY at three months follow-up. Average total costs per patient during 3 months follow-up were €2,094 for the CDMI group and €2,230 for the control group (excluding baseline costs). Bootstrapped SURE models resulted in a dominant ICER (i.e. less costs and a higher responder rate) for the CDMI group compared to the control group at three months follow-up. The same result was found for the costs per QALY gained. Various sensitivity analyses attested to the robustness of the findings of the main analysis. CONCLUSIONS This study demonstrated that brief and low-threshold web-based unguided self-help CDMIs have the potential to be a cost-effective addition to usual care for adults with mild-to-moderate depressive symptoms. The CDMIs were shown to improve health status while at the same time reduced healthcare costs of participants and hence dominates the care as usual control condition. As intervention costs are relatively low, and Internet is nowadays readily available in the Western world, we believe the CDMIs can be easily implemented on a large scale. CLINICALTRIAL Netherlands Trial Register (NTR): NTR4612; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4612 (Archived by WebCite at http://www.webcitation.org/6n4PVYddM)

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Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/jmir.3539 ◽

2014 ◽

Vol 16 (7) ◽

pp. e168 ◽

Cited By ~ 25

Author(s):

Anna S Geraedts ◽

Annet M Kleiboer ◽

Jos Twisk ◽

Noortje M Wiezer ◽

Willem van Mechelen ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Depressive Symptoms ◽

Controlled Trial ◽

Long Term Results ◽

Web Based ◽

Randomized Controlled ◽

Self Help

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Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/13655 ◽

2019 ◽

Vol 21 (10) ◽

pp. e13655 ◽

Cited By ~ 5

Author(s):

Rüdiger Zwerenz ◽

Carlotta Baumgarten ◽

Jan Becker ◽

Ana Tibubos ◽

Martin Siepmann ◽

...

Keyword(s):

Depressive Symptoms ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Inpatient Psychotherapy ◽

Web Based ◽

Randomized Controlled ◽

Self Help ◽

The Web

Background We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression. Objective The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up. Methods Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3). Results At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group. Conclusions Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists’ concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed. Trial Registration ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.

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