Complaint-Directed Mini-Interventions for Depressive Complaints: A Randomized Controlled Trial of Unguided Web-Based Self-Help Interventions

Abstract

BackgroundPrevention of depression is important due to the substantial burden of disease associated with it. To this end, we developed a novel, brief, and low-threshold Web-based self-help approach for depressive complaints called complaint-directed mini-interventions (CDMIs). These CDMIs focus on highly prevalent complaints that are demonstrably associated with depression and have a substantial economic impact: stress, sleep problems, and worry.ObjectiveThe aim was to evaluate the effectiveness of the Web-based self-help CDMIs in a sample of adults with mild-to-moderate depressive symptoms compared to a wait-list control group.MethodsA two-armed randomized controlled trial was conducted. An open recruitment strategy was used. Participants were randomized to either the Web-based CDMIs or the no-intervention wait-list control group. The CDMIs are online, unguided, self-help interventions, largely based on cognitive behavioral techniques, which consist of 3 to 4 modules with up to 6 exercises per module. Participants are free to choose between the modules and exercises. Assessments, using self-report questionnaires, took place at baseline and at 3 and 6 months after baseline. The control group was given access to the intervention following the 3-month assessment. The primary goal of the CDMIs is to reduce depressive complaints. The primary outcome of the study was a reduction in depressive complaints as measured by the Inventory of Depressive Symptomatology Self-Report (IDS-SR). Secondary outcomes included reductions in stress, worry, sleep problems, and anxiety complaints, and improvements in well-being. Data were analyzed using linear mixed models.ResultsIn total, 329 participants enrolled in the trial, of which 165 were randomized to the intervention group and 164 to the control group. Approximately three-quarters of the intervention group actually created an account. Of these participants, 91.3% (116/127) logged into their chosen CDMI at least once during the 3-month intervention period (median 3, range 0-166). After 3 months, there was a significant reduction in depressive symptomatology for participants in the intervention group compared to participants in the wait-list control group (reduction in depression: mean –4.47, 95% CI –6.54 to –2.40; Cohen d=–0.70). Furthermore, significant effects were observed for sleep problems, worry, anxiety, and well-being, with effect sizes ranging from –0.29 to –0.40. The intervention did not significantly reduce stress. At 6-month follow-up, the improvements in the intervention group were generally sustained.ConclusionsThis study shows that the online self-help CDMIs have a positive impact on various mental health outcomes. Future research should focus on which specific strategies may boost adherence, and increase the reach of the CDMIs among people with low socioeconomic status.ClinicalTrialNetherlands Trial Register (NTR): NTR4612; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4612 (Archived by WebCite at http://www.webcitation.org/6n4PVYddM)

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

“…This economic evaluation was embedded in a randomized controlled trial (see Lokman et al [19]). The study entailed two-arms in which three web-based CMDIs were compared to a nointervention waiting-list control group.…”

“…These participants were referred to contact their GP or an anonymous online platform for people with suicidal thoughts. The required sample size for this study to achieve a power of 80%, was estimated to be 292 ( 2017 [19].…”

“…Some modules, such as relaxation, are relevant for all three complaints (sleep, stress, and worry) and are, therefore, part of all three CDMIs. A more detailed description of the CDMIs (including screenshots) can be found in Lokman et al 2017 [19]. Participants were advised to spend 2 to 3 hours a week on the CDMI for a period of at least 4 weeks.…”

Implementing complaint-directed mini-interventions for depressive complaints in primary care to increase participation among patients with a lower socioeconomic status: design of a cluster randomised controlled trial

“…In the present study, the online 'Complaint Directed Mini-Interventions' (CDMIs), which were found to be (cost-)effective in a self-guided format [17,18], will be implemented in the primary care setting using a blended care format (i.e. combining the e-health intervention with supporting face-to-face sessions that will be provided by the GP nurse).…”

“…The online CDMIs are short, low-threshold unguided web-based interventions that target depressive complaints by focussing on highly prevalent complaints that are demonstrably associated with depression and have a substantial economic impact: stress, sleep problems and worry [19]. There are three different CDMIs: 'Sleep better', 'Stress less' and 'Worry less', and each CDMI contains various modules and exercises (see [18] for more information). A feature of the CDMI intervention framework is that patients can choose the complaints that they want to focus on (by choosing the CDMIs that they want to use), and it also allows patients to choose the modules and exercises that they want to do and in what order (pick and mix).…”