TY - JOUR

T1 - Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial

AU - Schlicker, Sandra

AU - Weisel, Kiona K.

AU - Buntrock, Claudia

AU - Berking, Matthias

AU - Nobis, Stephanie

AU - Lehr, Dirk

AU - Baumeister, Harald

AU - Snoek, Frank J.

AU - Riper, Heleen

AU - Ebert, David D.

N1 - Funding Information: We acknowledge support by Deutsche Forschungsge-meinschaft and Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) within the funding programme Open Access Publishing. We also acknowledge the ethics board of the University of Marburg and thank Patrícia Kessler, who helped with dataset preparation as part of her master thesis. The study on which the analyses presented in this paper were based was funded by the European Union (EU ERDF: ZW6-80119999 and CCI 2007DE161PR001) and BARMER. Publisher Copyright: © 2019 Sandra Schlicker et al.

PY - 2019/5/14

Y1 - 2019/5/14

N2 - Introduction. Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Methods. Randomized controlled trial- (RCT-) based data (N = 253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES - D>40; N = 40). Results. Major depressive disorder diagnosis at the baseline (pprf6 = 0 01), higher levels of depression (Beck Depression Inventory II; pprpo = 0 00; pprf6 = 0 00), and lower HbA1c (pprpo = 0 04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (dprpo = 2 17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (dprpo = 0 92; 95% CI: 0.001-1.83), with a between-group effect size of dprpo = 1 05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ 2 2 N = 40 = 4 44; p < 0 02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (dpr6f = 0 71; 95% CI: 0.19-1.61) but not treatment response. Conclusion. Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.

AB - Introduction. Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Methods. Randomized controlled trial- (RCT-) based data (N = 253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES - D>40; N = 40). Results. Major depressive disorder diagnosis at the baseline (pprf6 = 0 01), higher levels of depression (Beck Depression Inventory II; pprpo = 0 00; pprf6 = 0 00), and lower HbA1c (pprpo = 0 04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (dprpo = 2 17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (dprpo = 0 92; 95% CI: 0.001-1.83), with a between-group effect size of dprpo = 1 05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ 2 2 N = 40 = 4 44; p < 0 02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (dpr6f = 0 71; 95% CI: 0.19-1.61) but not treatment response. Conclusion. Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.

KW - Psychology

UR - http://www.scopus.com/inward/record.url?scp=85068484979&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/167777f4-a83a-3018-8eec-65ffb246ea41/

U2 - 10.1155/2019/2634094

DO - 10.1155/2019/2634094

M3 - Journal articles

C2 - 31218230

VL - 2019

JO - Journal of Diabetes Research

JF - Journal of Diabetes Research

SN - 2314-6745

M1 - 2634094

ER -