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 2N=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.

Impact of technology use in type 2 diabetes distress: A systematic review

“…Data extraction items are shown in Table 1 . Of the nine articles analyzed, two did not present sample size calculations[ 15 , 22 ] including technique description. Three RCTs[ 17 , 19 , 23 ] used the DDS-17 items for the DD measure, four used the PAID-5[ 16 , 18 , 21 , 23 ], one used two subscales of the DDS, the five-item Regimen Distress subscale and the five-item Emotional Burden subscale version[ 15 ], and one used the PAID with 20 items[ 15 ].…”

“…Three RCTs[ 17 , 19 , 23 ] used the DDS-17 items for the DD measure, four used the PAID-5[ 16 , 18 , 21 , 23 ], one used two subscales of the DDS, the five-item Regimen Distress subscale and the five-item Emotional Burden subscale version[ 15 ], and one used the PAID with 20 items[ 15 ]. In terms of demographics, female gender was the majority in six articles[ 15 , 16 , 19 , 20 , 22 , 23 ], and in one, no gender reporting was found[ 17 ]. Follow-up varied from 8 to 48 wk.…”

“…Follow-up varied from 8 to 48 wk. One study had an 8-wk[ 16 ] period, one had 10 wk[ 20 ], two studies had 12 wk[ 17 , 23 ], three studies had 24 wk[ 18 , 21 , 22 ] and two had 48 wk[ 15 , 19 ] (Table 1 ).…”

“…Eight RCTs were scored with good quality (total score ≥ 3) and low bias risk. One study[ 22 ] was scored as poor quality with high bias risk. The main topic with the fewest points was blindness, and three articles had a double-blind design[ 19 , 20 , 23 ] (Table 2 ).…”

“…This review suggests that technology could have a positive impact on DD in T2D patients. The majority of articles selected for qualitative synthesis (six[ 16 , 17 , 19 , 20 , 23 ] out of nine[ 15 , 18 , 22 ]) showed significant DD scale improvement in the technology intervention groups over the initial data. Five articles[ 16 , 17 , 19 - 21 ] showed significant differences between groups.…”