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; Freund, Johanna; Thielecke, Janika; Ebert, David Daniel; Baumeister, Harald

doi:10.1016/j.jad.2020.09.066

Cited by 19 publications

(39 citation statements)

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“…A detailed overview can be found in the corresponding study protocol ( Braun et al, 2019 ). This article focuses on the 6- and 12-month FU results, while effectiveness results at T1 were already reported ( Braun et al, 2021 ). This research has been conducted in accordance with the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…As we took into account an attrition of 28% ( Richards and Richardson, 2012 ), overall 360 participants were included in the study. Effectiveness results for T2 and T3 were analyzed as cross-sectional measurement points analogue to previously reported effectiveness results for T1 ( Braun et al, 2021 ). In a second step, Second order latent Growth curve Models (SGMs) were modeled to analyze longitudinal growth.…”

Section: Methodsmentioning

confidence: 99%

“…Data analyses were performed with each data set and pooled according to Rubin's Rule ( Rubin, 1996 , Rubin, 1987 ). Imputation of missing data was based on the previously applied procedure for analysis of T1 ( Braun et al, 2021 ) and based on observed data T0–T3. Analyses were always conducted as Intention-to-Treat (ITT) analyses based on imputed data unless otherwise indicated.…”

Section: Methodsmentioning

confidence: 99%

“…The IBI program for depression health promotion in subthreshold (to clinical) depression was already shown to be effective for reduction of depressive symptoms severity at 9-week post-randomization in the occupational group of green professions compared to enhanced Treatment As Usual (TAU+) ( Braun et al, 2021 ). Moreover, the IBI program had an overall health-promoting effect as sleep quality, pain-associated disability and quality of life were also enhanced 9-week post-randomization ( Braun et al, 2021 ). Participants were classified as adherent to intervention protocol and thus, as a completer if they completed at least 80% of their IBI until 9-week post-randomization.…”

Section: Introductionmentioning

confidence: 99%

“…Participants were classified as adherent to intervention protocol and thus, as a completer if they completed at least 80% of their IBI until 9-week post-randomization. As completer rate was low at 9-week post-randomization with 22.2% of IG ( Braun et al, 2021 ), the continuing usage of the IBI program was monitored over the FU period of 12 months and program adherence was particularly taken into account in the assessment of program effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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Are guided internet-based interventions for the indicated prevention of depression in green professions effective in the long run? Longitudinal analysis of the 6- and 12-month follow-up of a pragmatic randomized controlled trial (PROD-A)

Braun

Titzler

Terhorst

et al. 2021

Internet Interventions

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Objective Evidence of long-term stability for positive mental health effects of internet-based interventions (IBIs) for depression prevention is still scarce. We evaluate long-term effectiveness of a depression prevention program in green professions (i.e. agriculture, horticulture, forestry). Methods This pragmatic RCT ( n = 360) compares a tailored IBI program to enhanced treatment as usual (TAU+) in green professions with at least subthreshold depression (PHQ ≥ 5). Intervention group (IG) received one of six IBIs shown previously to efficaciously reduce depressive symptoms. We report 6- and 12-month follow-up measures for depression, mental health and intervention-related outcomes. Intention-to-treat and per-protocol regression analyses were conducted for each measurement point and complemented by latent growth modeling. Results After 6 months, depression severity (β = −0.30, 95%-CI: −0.52; −0.07), insomnia (β = −0.22, 95%-CI: −0.41; −0.02), pain-associated disability (β = −0.26, 95%-CI: −0.48; −0.04) and quality of life (β = 0.29, 95%-CI: 0.13; 0.45) in IG were superior to TAU+. Onset of possible depression was not reduced. After 12 months, no intervention effects were found. Longitudinal modeling confirmed group effects attenuating over 12 months for most outcomes. After 12 months, 55.56% of IG had completed at least 80% of their IBI. Conclusions Stability of intervention effects along with intervention adherence was restricted. Measures enhancing long-term effectiveness of IBIs for depression health promotion are indicated in green professions. Trial registration German Clinical Trial Registration: DRKS00014000. Registered: 09 April 2018.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Are guided internet-based interventions for the indicated prevention of depression in green professions effective in the long run? Longitudinal analysis of the 6- and 12-month follow-up of a pragmatic randomized controlled trial (PROD-A)

Braun

Titzler

Terhorst

et al. 2021

Internet Interventions

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Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression

Terhorst,

Kaiser,

Brakemeier

et al. 2024

JAMA Netw Open

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ImportanceWhile the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary.ObjectiveTo investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness.Data SourcesA systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials.Study SelectionTitles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design.Data Extraction and SynthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted.Main Outcomes and MeasuresHeterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs.ResultsThe systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire–9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = −0.02; 95% credible interval [CrI], −0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = −0.56; 95% CrI, −0.46 to −0.66). An interaction effect between guidance and baseline severity was found (β̂ = −0.24, 95% CrI, −0.03 to −0.46).Conclusions and RelevanceIn this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.

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Prävention

Buntrock

Baumeister²,

Ebert

2023

Digitale Gesundheitsinterventionen

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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

Cited by 19 publications

References 94 publications

Are guided internet-based interventions for the indicated prevention of depression in green professions effective in the long run? Longitudinal analysis of the 6- and 12-month follow-up of a pragmatic randomized controlled trial (PROD-A)

Are guided internet-based interventions for the indicated prevention of depression in green professions effective in the long run? Longitudinal analysis of the 6- and 12-month follow-up of a pragmatic randomized controlled trial (PROD-A)

Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression

Prävention

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