Efficacy of Three Low-Intensity, Internet-Based Psychological Interventions for the Treatment of Depression in Primary Care: Randomized Controlled Trial

Abstract

Background Primary care is a major access point for the initial treatment of depression, but the management of these patients is far from optimal. The lack of time in primary care is one of the major difficulties for the delivery of evidence-based psychotherapy. During the last decade, research has focused on the development of brief psychotherapy and cost-effective internet-based interventions mostly based on cognitive behavioral therapy (CBT). Very little research has focused on alternative methods of treatment for depression using CBT. Thus, there is a need for research into other therapeutic approaches. Objective This study aimed to assess the effectiveness of 3 low-intensity, internet-based psychological interventions (healthy lifestyle psychoeducational program [HLP], focused program on positive affect promotion [PAPP], and brief intervention based on mindfulness [MP]) compared with a control condition (improved treatment as usual [iTAU]). Methods A multicenter, 4-arm, parallel randomized controlled trial was conducted between March 2015 and March 2016, with a follow-up of 12 months. In total, 221 adults with mild or moderate major depression were recruited in primary care settings from 3 Spanish regions. Patients were randomly distributed to iTAU (n=57), HLP (n=54), PAPP (n=56), and MP (n=54). All patients received iTAU from their general practitioners. The main outcome was the Spanish version of the Patient Health Questionnaire-9 (PHQ-9) from pretreatment (time 1) to posttreatment (time 2) and up to 6 (time 3) and 12 (time 4) months’ follow-up. Secondary outcomes included the visual analog scale of the EuroQol, the Short-Form Health Survey (SF-12), the Positive and Negative Affect Schedule (PANAS), and the Pemberton Happiness Index (PHI). We conducted regression models to estimate outcome differences along study stages. Results A moderate decrease was detected in PHQ-9 scores from HLP (β=–3.05; P=.01) and MP (β=–3.00; P=.01) compared with iTAU at posttreatment. There were significant differences between all intervention groups and iTAU in physical SF-12 scores at 6 months after treatment. Regarding well-being, MP and PAPP reported better PHI results than iTAU at 6 months post treatment. PAPP intervention significantly decreased PANAS negative affect scores compared with iTAU 12 months after treatment. Conclusions The low-intensity, internet-based psychological interventions (HLP and MP) for the treatment of depression in primary care are more effective than iTAU at posttreatment. Moreover, all low-intensity psychological interventions are also effective in improving medium- and long-term quality of life. PAPP is effective for improving health-related quality of life, negative affect, and well-being in patients with depression. Nevertheless, it is important to examine possible reasons that could be implicated for PAPP not being effective in reducing depressive symptomatology; in addition, more research is still needed to assess the cost-effectiveness analysis of these interventions. Trial Registration ISRCTN Registry ISRCTN82388279; http://www.isrctn.com/ISRCTN82388279 International Registered Report Identifier (IRRID) RR2-10.1186/s12888-015-0475-0

Predictors of Adherence in Three Low-Intensity Intervention Programs Applied by ICTs for Depression in Primary Care

“…The aim of the original study was to assess the effectiveness of three low-intensity intervention programs applied by ICTs (Healthy Lifestyle Program, Positive Affect Promotion Program and Mindfulness Program) compared with a control condition. The research protocol and main results have been reported elsewhere [ 35 , 36 ].…”

“…The Ethical Review Board of the regional health authority approved the study (Ref: IB 2144/13 PI). More details about the study design, recruitment, randomization and data collection procedure are described elsewhere [ 35 , 36 ].…”

Italia Ti Ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic

“…Other studies found significant reductions of depressive symptoms also through the delivery of mindfulness-based online interventions (Questret, Cropley, & Fife-Schaw, 2018;Gili et al, 2020;Shankaland et al, 2020). Again, considering anxiety features, several studies demonstrated the efficacy of web-and app-based psychological interventions on anxiety reduction (e.g., Questret, Cropley, & Fife-Schaw, 2018;Rasanen et al, 2016;Lopez et al, 2019;Nissen et al, 2019;Kladnitski et al, 2020).…”

A Low-Intensity Internet-Based Intervention Focused on the Promotion of Positive Affect for the Treatment of Depression in Spanish Primary Care: Secondary Analysis of a Randomized Controlled Trial

“…Given the potential of IBIs as low-intensity interventions in PC, we conducted a randomized control trial (RCT) in a sample of patients diagnosed with MDD in different PC settings in Spain [28]. In this study, we examined the effectiveness of three low-intensity IBIs (PA promotion vs. healthy lifestyle vs. mindfulness) along with improved treatment as usual (iTAU), compared to iTAU alone, and the results were promising [29]. Specifically, healthy lifestyle and mindfulness interventions were effective in reducing depression severity, compared to iTAU, at post-treatment.…”

“…The present study is a secondary analysis of the RCT carried out by Gili et al [29]. More specifically, this study carries out an in-depth examination of the role of a specific IBI to promote PA as an adjunct therapy to iTAU in PC settings, given PA's potential as a strategy to improve well-being in MDD patients.…”