Internet-delivered Cognitive Behavioural Therapy for Adults with Mild to Moderate Depression and High Cardiovascular Disease Risks: a Randomised Attention-controlled Trial

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2013 Apr 5

PMID 23555624

Citations 50

Authors

Nicholas Glozier

Helen Christensen

Sharon Naismith

Nicole Cockayne

Liesje Donkin

Bruce Neal

Andrew Mackinnon

Ian Hickie

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Mild to moderate depression is common in those with cardiovascular disease and undertreated. We aimed to evaluate the effectiveness of internet-delivered Cognitive Behaviour Therapy (iCBT) on depressive symptom severity and adherence to medical advice and lifestyle interventions in adults with mild to moderate depression and high cardiovascular disease (CVD) risks.

Methods: Randomised double-blind, 12 week attention-controlled trial comparing an iCBT programme (E-couch) with an internet-delivered attention control health information package (HealthWatch, n = 282). The primary outcome was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9) (trial registration: ACTRN12610000085077).

Results: 487/562 (88%) participants completed the endpoint assessment. 383/562 (70%) were currently treated for cardiovascular disease and 314/562 (56%) had at least one other comorbid condition. In ITT analysis of 562 participants iCBT produced a greater decline in the mean PHQ-9 score compared to the attention control of 1.06 (95% CI: 0.23-1.89) points, with differences between the two arms increasing over the intervention period (time by treatment effect interaction p = .012). There were also larger improvements in adherence (2.16 points; 95% CI: 0.33-3.99), reductions in anxiety (0.96 points; 95% CI: 0.19-1.73), and a greater proportion engaging in beneficial physical activity (Odds Ratio 1.91, 95%CI: 1.01-3.61) in the iCBT participants but no effect upon disability, or walking time/day. There were no withdrawals due to study related adverse events.

Conclusions: In people with mild to moderate depression and high levels of CVD risk factors, a freely accessible iCBT programme (http://www.ecouch.anu.edu.au) produced a small, but robust, improvement in depressive symptoms, adherence and some health behaviours.

Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12610000085077.

Citing Articles

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References

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

Jorm A, Christensen H, Griffiths K, Rodgers B . Effectiveness of complementary and self-help treatments for depression. Med J Aust. 2002; 176(10):S84-96. DOI: 10.5694/j.1326-5377.2002.tb04508.x. View

Christensen H, Griffiths K, Farrer L . Adherence in internet interventions for anxiety and depression. J Med Internet Res. 2009; 11(2):e13. PMC: 2762797. DOI: 10.2196/jmir.1194. View

Donkin L, Glozier N . Motivators and motivations to persist with online psychological interventions: a qualitative study of treatment completers. J Med Internet Res. 2012; 14(3):e91. PMC: 3414905. DOI: 10.2196/jmir.2100. View

Cockayne N, Glozier N, Naismith S, Christensen H, Neal B, Hickie I . Internet-based treatment for older adults with depression and co-morbid cardiovascular disease: protocol for a randomised, double-blind, placebo controlled trial. BMC Psychiatry. 2011; 11:10. PMC: 3034669. DOI: 10.1186/1471-244X-11-10. View

Eysenbach G . The law of attrition. J Med Internet Res. 2005; 7(1):e11. PMC: 1550631. DOI: 10.2196/jmir.7.1.e11. View

Donkin L, Hickie I, Christensen H, Naismith S, Neal B, Cockayne N . Sampling bias in an internet treatment trial for depression. Transl Psychiatry. 2012; 2:e174. PMC: 3565809. DOI: 10.1038/tp.2012.100. View

Brown W, Burton N, Marshall A, Miller Y . Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women. Aust N Z J Public Health. 2008; 32(6):535-41. DOI: 10.1111/j.1753-6405.2008.00305.x. View

Rieckmann N, Gerin W, Kronish I, Burg M, Chaplin W, Kong G . Course of depressive symptoms and medication adherence after acute coronary syndromes: an electronic medication monitoring study. J Am Coll Cardiol. 2006; 48(11):2218-22. DOI: 10.1016/j.jacc.2006.07.063. View

10.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F . Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364(9438):937-52. DOI: 10.1016/S0140-6736(04)17018-9. View

11.

Maruff P, Thomas E, Cysique L, Brew B, Collie A, Snyder P . Validity of the CogState brief battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex. Arch Clin Neuropsychol. 2009; 24(2):165-78. DOI: 10.1093/arclin/acp010. View

12.

Kessler R, Andrews G, Colpe L, Hiripi E, Mroczek D, Normand S . Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002; 32(6):959-76. DOI: 10.1017/s0033291702006074. View

13.

Banks E, Redman S, Jorm L, Armstrong B, Bauman A, Beard J . Cohort profile: the 45 and up study. Int J Epidemiol. 2007; 37(5):941-7. PMC: 2557061. DOI: 10.1093/ije/dym184. View

14.

Donker T, Griffiths K, Cuijpers P, Christensen H . Psychoeducation for depression, anxiety and psychological distress: a meta-analysis. BMC Med. 2009; 7:79. PMC: 2805686. DOI: 10.1186/1741-7015-7-79. View

15.

Christensen H, Griffiths K, Korten A . Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores. J Med Internet Res. 2002; 4(1):e3. PMC: 1761927. DOI: 10.2196/jmir.4.1.e3. View

16.

Mealing N, Banks E, Jorm L, Steel D, Clements M, Rogers K . Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs. BMC Med Res Methodol. 2010; 10:26. PMC: 2868856. DOI: 10.1186/1471-2288-10-26. View

17.

Knudsen A, Hotopf M, Skogen J, Overland S, Mykletun A . The health status of nonparticipants in a population-based health study: the Hordaland Health Study. Am J Epidemiol. 2010; 172(11):1306-14. DOI: 10.1093/aje/kwq257. View

18.

Andrews G, Cuijpers P, Craske M, McEvoy P, Titov N . Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010; 5(10):e13196. PMC: 2954140. DOI: 10.1371/journal.pone.0013196. View

19.

Ziegelstein R, Fauerbach J, STEVENS S, Romanelli J, Richter D, Bush D . Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med. 2000; 160(12):1818-23. DOI: 10.1001/archinte.160.12.1818. View

20.

Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B . Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007; 370(9590):851-8. DOI: 10.1016/S0140-6736(07)61415-9. View