No Sustainable Effects of an Internet-Based Relapse Prevention Program over 24 Months in Recurrent Depression: Primary Outcomes of a Randomized Controlled Trial

Klein, Nicola S.; Kok, Gemma; Burger, Huibert; Valen, Evelien van; Riper, Heleen; Cuijpers, Pim; Dekker, Jack; Smit, Filip; Heiden, Colin van der; Bockting, Claudi

doi:10.1159/000485039

Cited by 19 publications

(26 citation statements)

References 9 publications

(13 reference statements)

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“…The exact relapse and recurrence rates vary in the literature. High relapse rates of 39 to 54% after acute, maintenance, and preventive treatment suggest that current treatments are suboptimal and not effective for all individuals Cuijpers, 2017;Klein et al, 2018;Kuyken et al, 2016;Steinert, Hofmann, Kruse, & Leichsenring, 2014;Vittengl, Clark, Dunn, & Jarrett, 2007). Identifying factors that increase the risk of depressive relapse is therefore necessary in order to improve existing treatment options to prevent the re-occurrence of MDD, and to inform on therapeutic targets.…”

Section: Introductionmentioning

confidence: 99%

Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies

Brouwer

Williams

Kennis

et al. 2019

Clinical Psychology Review

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Theory-derived psychological vulnerabilities are presumed to predict depressive relapse. • There were few prospective studies examining psychological theories of relapse. • There is some support for cognitive, behavioural, and personality theories. • There was no support for psychodynamic and no studies for diatheses-stress theories. • There is an overall lack of research on psychological theories of depressive relapse.

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Section: Introductionmentioning

confidence: 99%

Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies

Brouwer

Williams

Kennis

et al. 2019

Clinical Psychology Review

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“…The large effects on insomnia severity are important towards prevention of mental health problems for which insomnia is a risk factor as well [4]. Although further research is needed to illuminate potential effects on other mental health complaints and daily functioning and the longerterm effects of online interventions [56], we recommend GPs to implement nurse-guided I-CBT-I as a way of alleviating insomnia symptoms through feasible, effective, guideline adherent treatment.…”

Section: Discussionmentioning

confidence: 99%

Nurse-Guided Internet-Delivered Cognitive Behavioral Therapy for Insomnia in General Practice: Results from a Pragmatic Randomized Clinical Trial

Zweerde

Lancee

Slottje

et al. 2020

Psychother Psychosom

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Introduction: Guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) as the first line of treatment for insomnia in general practice, but CBT-I is rarely available. Nurse-guided Internet-delivered CBT-I might be a solution to improve access to care. Objective: We aimed to determine the effectiveness of nurse-guided Internet-delivered CBT-I (I-CBT-I) on insomnia severity experienced by patients in general practice. Methods: Nurse-guided I-CBT-I (“i-Sleep”) was compared to care-as-usual (and I-CBT-I after 6 months) in 15 participating general practices among 134 patients (≥18 years old) with clinical insomnia symptoms. Assessments took place at 8, 26 and 52 weeks. Primary outcome was self-reported insomnia severity (Insomnia Severity Index) at 8 weeks. Secondary outcomes were sleep diary indices, depression and anxiety symptoms (Hospital Anxiety and Depression Scale), fatigue, daytime consequences of insomnia, sleep medication and adverse events. Results: Two thirds of the 69 intervention patients (n = 47; 68%) completed the whole intervention. At the posttest examination, there were large significant effects for insomnia severity (Cohen’s d =1.66), several sleep diary variables (wake after sleep onset, number of awakenings, terminal wakefulness, sleep efficiency, sleep quality) and depression. At 26 weeks there were still significant effects on insomnia severity (d = 1.02) and on total sleep time and sleep efficiency. No significant effects were observed for anxiety, fatigue, daily functioning or sleep medication. No adverse events were reported. Conclusions: Nurse-guided I-CBT-I effectively reduces insomnia severity among general practice patients. I-CBT-I enables general practitioners to offer effective insomnia care in accordance with the clinical guidelines.

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“…The economic evaluation was conducted and reported according to the Consolidated Health Economic Evaluation Reporting Standards statement (Multimedia Appendix 2). The study design and results are described in detail elsewhere [20,22] but are summarized briefly here.…”

Section: Methodsmentioning

confidence: 99%

“…The power calculation of the primary outcome is described elsewhere [20,22]. Since the study was only powered to detect differences in health outcomes and not in costs, as in most economic evaluations, we used probabilistic and medical decision-making techniques to draw inferences about the cost effectiveness.…”

Section: Methodsmentioning

confidence: 99%

“…In our randomized controlled trial (RCT), we examined the clinical effectiveness of an internet-based relapse prevention program (mobile cognitive therapy, M-CT) added to treatment as usual (TAU) compared to TAU alone in remitted individuals with recurrent MDD. Results showed that M-CT added to TAU was slightly but not significantly superior to TAU alone after 24 months in terms of cumulative relapse/recurrence rate, number of depressive relapses, and depressive symptoms [20]. In this study, we evaluated the cost effectiveness and cost utility of M-CT to see if the economic case could be made for this low-cost and highly scalable intervention that was added to TAU.…”

Section: Introductionmentioning

confidence: 99%

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Economic Evaluation of an Internet-Based Preventive Cognitive Therapy With Minimal Therapist Support for Recurrent Depression: Randomized Controlled Trial

Klein¹,

Bockting²,

Wijnen³

et al. 2018

J Med Internet Res

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BackgroundMajor depressive disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost effectiveness, especially in recurrent MDD.ObjectivesOur aim was to evaluate the cost effectiveness and cost utility of an internet-based relapse prevention program (mobile cognitive therapy, M-CT).MethodsThe economic evaluation was performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to treatment as usual (TAU) or TAU alone. M-CT comprised 8 online lessons, and participants were advised to complete 1 lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-adjusted life years (QALYs) were self-assessed with the three level version of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L). Costs were assessed with the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness (TiC-P). Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that M-CT is cost effective compared to TAU.ResultsMean total costs over 24 months were €8298 (US $9415) for M-CT and €7296 (US $8278) for TAU. No statistically significant differences were found between M-CT and TAU regarding depression-free days and QALYs (P=.37 and P=.92, respectively). The incremental costs were €179 (US $203) per depression-free day and €230,816 (US $261,875) per QALY. The cost-effectiveness acceptability curves suggested that for depression-free days, high investments have to be made to reach an acceptable probability that M-CT is cost effective compared to TAU. Regarding QALYs, considerable investments have to be made but the probability that M-CT is cost effective compared to TAU does not rise above 40%.ConclusionsThe results suggest that adding M-CT to TAU is not effective and cost effective compared to TAU alone. Adherence rates were similar to other studies and therefore do not explain this finding. The participants scarcely booked additional therapist support, resulting in 17.3 minutes of mean total therapist support. More studies are needed to examine the cost effectiveness of internet-based interventions with respect to long-term outcomes and the role and optimal dosage of therapist support. Overall, more resea...

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No Sustainable Effects of an Internet-Based Relapse Prevention Program over 24 Months in Recurrent Depression: Primary Outcomes of a Randomized Controlled Trial

Cited by 19 publications

References 9 publications

Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies

Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies

Nurse-Guided Internet-Delivered Cognitive Behavioral Therapy for Insomnia in General Practice: Results from a Pragmatic Randomized Clinical Trial

Economic Evaluation of an Internet-Based Preventive Cognitive Therapy With Minimal Therapist Support for Recurrent Depression: Randomized Controlled Trial

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