Effectiveness of an Internet-Based Self-Guided Program to Treat Depression in a Sample of Brazilian Users: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Depression is undertreated in Brazil. Deprexis is an internet-based program to treat depressive symptoms based on empirically supported integrative and cognitive-behavioral therapy. Evidence from metanalysis supports Deprexis’ efficacy in German-speaking countries and the United States of America, but no study has yet been conducted using this program in countries with low literacy rates and large social disparities. Furthermore, few studies have investigated whether internet-based interventions ameliorate psychological processes that might underlie depressive symptomatology, such as low perceived self-efficacy. OBJECTIVE To evaluate the effectiveness of the Brazilian-Portuguese version of Deprexis in a sample of Brazilian adults with elevated depressive symptoms. METHODS We randomized 189 moderately to severely depressed participants to an intervention condition (treatment as usual [TAU] plus immediate access to Deprexis for 90 days, n=94), or to a control condition (TAU and delayed access to Deprexis, after 8 weeks, n=95). RESULTS Intention-to-treat analysis using a linear mixed model showed that participants who received Deprexis improved significantly more than participants assigned to the delayed access control group on the primary depression measure (Cohen's d=0.80), and secondary outcomes such as general psychological state measure (d=0.82), and the perceived self-efficacy measure (d=0.63). ITT analyses show that 21.3% of the participants achieved remission against 7.4% in the control group (p < 0.001). Participants reported a medium to high level of satisfaction with Deprexis. CONCLUSIONS These results replicate previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months for a depressed sample of Brazilian users. It extends previous research by showing significant effects on perceived self-efficacy. CLINICALTRIAL ReBec RBR-6kk3bx, UTN U1111-1212-8998 INTERNATIONAL REGISTERED REPORT RR2-10.1590/1516-4446-2019-0582