Effectiveness of guided internet-based interventions in the indicated prevention of depression in green professions (PROD-A): Results of a pragmatic randomized controlled trial

Lina Braun; Ingrid Titzler; Yannik Terhorst; Johanna Freund; Janika Thielecke; David Daniel Ebert; Harald Baumeister

doi:10.1016/j.jad.2020.09.066

Effectiveness of guided internet-based interventions in the indicated prevention of depression in green professions (PROD-A): Results of a pragmatic randomized controlled trial

Lina Braun^*
, Ingrid Titzler
, Yannik Terhorst
, Johanna Freund
, Janika Thielecke
, David Daniel Ebert
, Harald Baumeister

^*Corresponding author for this work

Clinical Psychology

Research output: Contribution to Journal › Article › Academic › peer-review

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Abstract

Background: Major Depressive Disorder (MDD) has a major impact on public health. Reduction of depression burden in general population is of greatest importance and might be achieved by implementation of depression prevention measures into routine care. We evaluate an online prevention measure as part of a national project aiming to reduce depression in the occupational group of green professions. Methods: This two-armed pragmatic RCT (n = 360) evaluates the effectiveness of a tailored internet-based intervention (IMI) program compared to enhanced treatment as usual. The IMI program entailed access to one of six guided IMIs each focusing on different symptom areas (depressive mood with optional comorbid diabetes, perceived stress, insomnia, panic and agoraphobia and harmful alcohol consumption). Eligible were entrepreneurs, spouses, family members and pensioners in green professions with adequate insurance status and at least subthreshold depression (PHQ≥5). Primary outcome was depressive symptom severity (QIDS-SR16) at 9-weeks post-treatment (T1). Various secondary outcomes were assessed at T1. Results: A small effect of depression reduction (d=-0.28, 95%-CI: -0.50 to -0.07) was found at T1 favouring the IMI program (β=-0.22, 95%-CI: -0.41 to -0.02, p=.033). Categorical analysis indicated a reduced risk of potential MDD with NNTB=28.11. Adherence to the IMI program at T1 was exceptionally low. Limitations: Results are limited to green professions and representativeness might be restricted by self-selection of participants. Conclusion: Depression burden in green professions can be reduced by this online prevention measure. Yet, short-term effectiveness is restricted by low adherence rates. Trial Registration: German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018.

Original language	English
Pages (from-to)	658-671
Number of pages	14
Journal	Journal of Affective Disorders
Volume	278
Early online date	15 Sept 2020
DOIs	https://doi.org/10.1016/j.jad.2020.09.066
Publication status	Published - 1 Jan 2021

Funding

Funding for this study is based on a financial contribution by the social insurance company (SVLFG) to the University of Ulm and Friedrich-Alexander-University Erlangen-Nürnberg. SVLFG had no role in study design, data collection, analyses, decision to publish or preparation of this manuscript. SVLFG will not be involved in decision to publish or preparation of future papers regarding PROD-A. Assoc. Prof. Dr. David Daniel Ebert (DDE) reports to have received consultancy fees/served in the scientific advisory board from several companies such as Minddistrict, Lantern, Novartis, Sanofi, Schoen Kliniken, Ideamed, German health insurance companies (BARMER, Techniker Krankenkasse) and a number of federal chambers for psychotherapy. He is stakeholder of the Institute for health training online (GET.ON), which aims to implement scientific findings related to digital health interventions into routine care. Prof. Harald Baumeister (HB) reports to have received consultancy fees and fees for lectures/workshops from chambers of psychotherapists and training institutes for psychotherapists in the e-mental-health context. Ingrid Titzler (IT) reports to have received fees for lectures/workshops in the e-mental-health context from training institutes for psychotherapists. She is project lead of the trial site Institute for health training online (GET.ON) for the European implementation research project ImpleMentAll funded by the European Commission. All authors linked to GET.ON institute (DDE, IT) had no influence over analysis and interpretation of study results. The remaining authors report no conflicts of interest.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Depression
Green professions
Internet- and mobile-based interventions
Prevention
Randomized controlled trial

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Effectiveness of guided internet-based interventions in the indicated prevention of depression in green professionsFinal published version, 1.27 MBLicence: Article 25fa Dutch Copyright Act

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@article{90753304f30041fdbe4ebd0b8a775c0e,

title = "Effectiveness of guided internet-based interventions in the indicated prevention of depression in green professions (PROD-A): Results of a pragmatic randomized controlled trial",

abstract = "Background: Major Depressive Disorder (MDD) has a major impact on public health. Reduction of depression burden in general population is of greatest importance and might be achieved by implementation of depression prevention measures into routine care. We evaluate an online prevention measure as part of a national project aiming to reduce depression in the occupational group of green professions. Methods: This two-armed pragmatic RCT (n = 360) evaluates the effectiveness of a tailored internet-based intervention (IMI) program compared to enhanced treatment as usual. The IMI program entailed access to one of six guided IMIs each focusing on different symptom areas (depressive mood with optional comorbid diabetes, perceived stress, insomnia, panic and agoraphobia and harmful alcohol consumption). Eligible were entrepreneurs, spouses, family members and pensioners in green professions with adequate insurance status and at least subthreshold depression (PHQ≥5). Primary outcome was depressive symptom severity (QIDS-SR16) at 9-weeks post-treatment (T1). Various secondary outcomes were assessed at T1. Results: A small effect of depression reduction (d=-0.28, 95\%-CI: -0.50 to -0.07) was found at T1 favouring the IMI program (β=-0.22, 95\%-CI: -0.41 to -0.02, p=.033). Categorical analysis indicated a reduced risk of potential MDD with NNTB=28.11. Adherence to the IMI program at T1 was exceptionally low. Limitations: Results are limited to green professions and representativeness might be restricted by self-selection of participants. Conclusion: Depression burden in green professions can be reduced by this online prevention measure. Yet, short-term effectiveness is restricted by low adherence rates. Trial Registration: German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018.",

keywords = "Depression, Green professions, Internet- and mobile-based interventions, Prevention, Randomized controlled trial",

author = "Lina Braun and Ingrid Titzler and Yannik Terhorst and Johanna Freund and Janika Thielecke and Ebert, \{David Daniel\} and Harald Baumeister",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/j.jad.2020.09.066",

language = "English",

volume = "278",

pages = "658--671",

journal = "Journal of Affective Disorders",

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Effectiveness of guided internet-based interventions in the indicated prevention of depression in green professions (PROD-A): Results of a pragmatic randomized controlled trial. / Braun, Lina; Titzler, Ingrid; Terhorst, Yannik et al.
In: Journal of Affective Disorders, Vol. 278, 01.01.2021, p. 658-671.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Effectiveness of guided internet-based interventions in the indicated prevention of depression in green professions (PROD-A)

T2 - Results of a pragmatic randomized controlled trial

AU - Braun, Lina

AU - Titzler, Ingrid

AU - Terhorst, Yannik

AU - Freund, Johanna

AU - Thielecke, Janika

AU - Ebert, David Daniel

AU - Baumeister, Harald

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Background: Major Depressive Disorder (MDD) has a major impact on public health. Reduction of depression burden in general population is of greatest importance and might be achieved by implementation of depression prevention measures into routine care. We evaluate an online prevention measure as part of a national project aiming to reduce depression in the occupational group of green professions. Methods: This two-armed pragmatic RCT (n = 360) evaluates the effectiveness of a tailored internet-based intervention (IMI) program compared to enhanced treatment as usual. The IMI program entailed access to one of six guided IMIs each focusing on different symptom areas (depressive mood with optional comorbid diabetes, perceived stress, insomnia, panic and agoraphobia and harmful alcohol consumption). Eligible were entrepreneurs, spouses, family members and pensioners in green professions with adequate insurance status and at least subthreshold depression (PHQ≥5). Primary outcome was depressive symptom severity (QIDS-SR16) at 9-weeks post-treatment (T1). Various secondary outcomes were assessed at T1. Results: A small effect of depression reduction (d=-0.28, 95%-CI: -0.50 to -0.07) was found at T1 favouring the IMI program (β=-0.22, 95%-CI: -0.41 to -0.02, p=.033). Categorical analysis indicated a reduced risk of potential MDD with NNTB=28.11. Adherence to the IMI program at T1 was exceptionally low. Limitations: Results are limited to green professions and representativeness might be restricted by self-selection of participants. Conclusion: Depression burden in green professions can be reduced by this online prevention measure. Yet, short-term effectiveness is restricted by low adherence rates. Trial Registration: German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018.

AB - Background: Major Depressive Disorder (MDD) has a major impact on public health. Reduction of depression burden in general population is of greatest importance and might be achieved by implementation of depression prevention measures into routine care. We evaluate an online prevention measure as part of a national project aiming to reduce depression in the occupational group of green professions. Methods: This two-armed pragmatic RCT (n = 360) evaluates the effectiveness of a tailored internet-based intervention (IMI) program compared to enhanced treatment as usual. The IMI program entailed access to one of six guided IMIs each focusing on different symptom areas (depressive mood with optional comorbid diabetes, perceived stress, insomnia, panic and agoraphobia and harmful alcohol consumption). Eligible were entrepreneurs, spouses, family members and pensioners in green professions with adequate insurance status and at least subthreshold depression (PHQ≥5). Primary outcome was depressive symptom severity (QIDS-SR16) at 9-weeks post-treatment (T1). Various secondary outcomes were assessed at T1. Results: A small effect of depression reduction (d=-0.28, 95%-CI: -0.50 to -0.07) was found at T1 favouring the IMI program (β=-0.22, 95%-CI: -0.41 to -0.02, p=.033). Categorical analysis indicated a reduced risk of potential MDD with NNTB=28.11. Adherence to the IMI program at T1 was exceptionally low. Limitations: Results are limited to green professions and representativeness might be restricted by self-selection of participants. Conclusion: Depression burden in green professions can be reduced by this online prevention measure. Yet, short-term effectiveness is restricted by low adherence rates. Trial Registration: German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018.

KW - Depression

KW - Green professions

KW - Internet- and mobile-based interventions

KW - Prevention

KW - Randomized controlled trial

UR - https://www.scopus.com/pages/publications/85092931965

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U2 - 10.1016/j.jad.2020.09.066

DO - 10.1016/j.jad.2020.09.066

M3 - Article

C2 - 33096333

AN - SCOPUS:85092931965

SN - 0165-0327

VL - 278

SP - 658

EP - 671

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -

Effectiveness of guided internet-based interventions in the indicated prevention of depression in green professions (PROD-A): Results of a pragmatic randomized controlled trial

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