Internet-Delivered Cognitive Behavioural Therapy for Adults with Mild to Moderate Depression and High Cardiovascular Disease Risks: A Randomised Attention-Controlled Trial

Abstract

Background and AimMild to moderate depression is common in those with cardiovascular disease and undertreated. We aimed to evaluate the effectiveness of internet-delivered Cognitive Behaviour Therapy (iCBT) on depressive symptom severity and adherence to medical advice and lifestyle interventions in adults with mild to moderate depression and high cardiovascular disease (CVD) risks.MethodsRandomised double-blind, 12 week attention-controlled trial comparing an iCBT programme (E-couch) with an internet-delivered attention control health information package (HealthWatch, n = 282). The primary outcome was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9) (trial registration: ACTRN12610000085077).Results487/562 (88%) participants completed the endpoint assessment. 383/562 (70%) were currently treated for cardiovascular disease and 314/562 (56%) had at least one other comorbid condition. In ITT analysis of 562 participants iCBT produced a greater decline in the mean PHQ-9 score compared to the attention control of 1.06 (95% CI: 0.23–1.89) points, with differences between the two arms increasing over the intervention period (time by treatment effect interaction p = .012). There were also larger improvements in adherence (2.16 points; 95% CI: 0.33–3.99), reductions in anxiety (0.96 points; 95% CI: 0.19–1.73), and a greater proportion engaging in beneficial physical activity (Odds Ratio 1.91, 95%CI: 1.01–3.61) in the iCBT participants but no effect upon disability, or walking time/day. There were no withdrawals due to study related adverse events.ConclusionsIn people with mild to moderate depression and high levels of CVD risk factors, a freely accessible iCBT programme (http://www.ecouch.anu.edu.au) produced a small, but robust, improvement in depressive symptoms, adherence and some health behaviours.Trial RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000085077

Evidence-Based Evaluation of eHealth Interventions: Systematic Literature Review

“…However, concerning case studies, all conducted evaluation at the end of the intervention. Although several aspects of evaluation have been found in conceptual articles [32][33][34][35][36][37][38][39]41], the case studies mostly evaluated clinical [20,[42][43][44][46][47][48][49][52][53]55,[59][60][61][64][65], and human/social aspects [42,[46][47][48][49][53][54][55]59,61,63,65].…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…przedział ufności {CI} 0,31; 0,86)] [245]. Terapia poznawczo-behawioralna przez internet u pacjentów z depresją i wysokim ryzykiem CVD powodowała niewielkie, lecz zdecydowane zmniejszenie objawów depresji, poprawę stosowania się do zaleceń i niektórych zachowań zdrowotnych [246].…”

Effects of a Health‐Partner Intervention on Cardiovascular Risk

“…To this effect, various lifestyle and nonpharmacological interventions have been examined in cardiac and noncardiac patient populations and have used cognitive‐behavioral strategies, including motivational interviewing, goal setting, continued support, promotion of clinical self‐knowledge and efficacy, as well as self‐monitoring and management 2, 3, 4. These measures have been delivered by health care providers, computer programs, or online interfaces, predominantly in patients with established CVD or its risk factors 5, 6, 7, 8, 9, 10, 11…”