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

Sandra Schlicker, Kiona K. Weisel, Claudia Buntrock, Matthias Berking, Stephanie Nobis, Dirk Lehr, Harald Baumeister, Frank J. Snoek, Heleen Riper, David D. Ebert

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

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%; χ2 (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.

Original languageEnglish
Number of pages1
JournalJournal of diabetes research
Volume2019
DOIs
Publication statusPublished - 1 Jan 2019

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Pragmatic Clinical Trials
Internet
Depression
Confidence Intervals
Control Groups
Major Depressive Disorder
Cognitive Therapy
Type 1 Diabetes Mellitus

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Schlicker, Sandra ; Weisel, Kiona K. ; Buntrock, Claudia ; Berking, Matthias ; Nobis, Stephanie ; Lehr, Dirk ; Baumeister, Harald ; Snoek, Frank J. ; Riper, Heleen ; Ebert, David D. / Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial. In: Journal of diabetes research. 2019 ; Vol. 2019.
@article{3ae487acb2c0466a8eae95b5688671ce,
title = "Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial",
abstract = "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{\%}; χ2 (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.",
author = "Sandra Schlicker and Weisel, {Kiona K.} and Claudia Buntrock and Matthias Berking and Stephanie Nobis and Dirk Lehr and Harald Baumeister and Snoek, {Frank J.} and Heleen Riper and Ebert, {David D.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1155/2019/2634094",
language = "English",
volume = "2019",
journal = "Journal of diabetes research",
issn = "2314-6753",
publisher = "Hindawi",

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Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial. / Schlicker, Sandra; Weisel, Kiona K.; Buntrock, Claudia; Berking, Matthias; Nobis, Stephanie; Lehr, Dirk; Baumeister, Harald; Snoek, Frank J.; Riper, Heleen; Ebert, David D.

In: Journal of diabetes research, Vol. 2019, 01.01.2019.

Research output: Contribution to JournalArticleAcademicpeer-review

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.

PY - 2019/1/1

Y1 - 2019/1/1

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%; χ2 (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%; χ2 (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.

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U2 - 10.1155/2019/2634094

DO - 10.1155/2019/2634094

M3 - Article

VL - 2019

JO - Journal of diabetes research

JF - Journal of diabetes research

SN - 2314-6753

ER -