Supportive monitoring and disease management through the internet: An internet-delivered intervention strategy for recurrent depression

Kordy, Hans; Backenstraß, Matthias; Hüsing, Johannes; Wolf, Markus; Aulich, Kai; Bürgy, M.; Puschner, Bernd; Rummel‐Kluge, Christine; Vedder, Helmut

doi:10.1016/j.cct.2013.08.005

Cited by 20 publications

(19 citation statements)

References 44 publications

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“…Details of the design and methods have been published elsewhere [36]; the methods are briefly summarized here. This trial is registered in the German Clinical Trials Register (ID: DRKS00000435).…”

Section: Methodsmentioning

confidence: 99%

“…In both strategies, patients were accompanied via e-mail and/or smartphone for 12 months after the inpatient index treatment, aiming to strengthen self-management skills and empowerment [36]. Automated supportive monitoring based on the Brief Patient-Health Questionnaire (PHQ-9) [39] enabled patients to evaluate the course of their depression [40].…”

Section: Methodsmentioning

confidence: 99%

“…Weeks with PSR ≤2 were considered well weeks (symptoms mostly absent) and weeks with PSR ≥3 were unwell weeks (at least mild symptoms). The ratio of well to unwell weeks was estimated by the ratio of transition rates from well to unwell, and back, which approximates the OR with respect to weeks between a well status and treatment conditions [36]. …”

Section: Methodsmentioning

confidence: 99%

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Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

Kordy

Wolf

Aulich

et al. 2016

Psychother Psychosom

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Background: Strategies to improve the life of patients suffering from recurrent major depression have a high relevance. This study examined the efficacy of 2 Internet-delivered augmentation strategies that aim to prolong symptom-free intervals. Methods: Efficacy was tested in a 3-arm, multicenter, open-label, evaluator-blind, randomized controlled trial. Upon discharge from inpatient mental health care, 232 adults with 3 or more major depressive episodes were randomized to 1 of 2 intervention groups (SUMMIT or SUMMIT-PERSON) or to treatment as usual (TAU) alone. Over 12 months, participants in both intervention arms received, in addition to TAU, intense monitoring via e-mail or a smartphone, including signaling of upcoming crises, assistance with personal crisis management, and facilitation of early intervention. SUMMIT-PERSON additionally offered regular expert chats. The primary outcome was ‘well weeks', i.e. weeks with at most mild symptoms assessed by the Longitudinal Interval Follow-Up Evaluation, during 24 months after the index treatment. Results: SUMMIT compared to TAU reduced the time with an unwell status (OR 0.48; 95% CI 0.23-0.98) through faster transitions from unwell to well (OR 1.44; 95% CI 0.83-2.50) and slower transitions from well to unwell (OR 0.69; 95% CI 0.44-1.09). Contrary to the hypothesis, SUMMIT-PERSON was not superior to either SUMMIT (OR 0.77; 95% CI 0.38-1.56) or TAU (OR 0.62; 95% CI 0.31-1.24). The efficacy of SUMMIT was strongest 8 months after the intervention. Conclusions: The fully automated Internet-delivered augmentation strategy SUMMIT has the potential to improve TAU by reducing the lifelong burden of patients with recurrent depression. The fact that the effects wear off suggests a time-unlimited extension.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

Kordy

Wolf

Aulich

et al. 2016

Psychother Psychosom

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“…Recent randomized controlled trials indicate that internet based CT started after (partial) remission is effective preventing a rise in depressive symptomatology and in preventing relapse and recurrence (Holländare et al, 2011(Holländare et al, , 2013Kok et al, 2015). In addition, using technical devices to support ongoing patient monitoring, such as text messages and apps for smart phones might facilitate long term monitoring on relapse (Bockting, Elgersma, et al, 2011;Bockting, Kok, et al, 2011;Kordy et al, 2013).…”

Section: Future Directionsmentioning

confidence: 99%

A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence

Bockting

Hollon

Jarrett

et al. 2015

Clinical Psychology Review

241

227

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Major depressive disorder (MDD) is highly disabling and typically runs a recurrent course. Knowledge about prevention of relapse and recurrence is crucial to the long-term welfare of people who suffer from this disorder. This article provides an overview of the current evidence for the prevention of relapse and recurrence using psychological interventions. We first describe a conceptual framework to preventive interventions based on: acute treatment; continuation treatment, or; prevention strategies for patients in remission. In brief, cognitive-behavioral interventions, delivered during the acute phase, appear to have an enduring effect that protects patients against relapse and perhaps others from recurrence following treatment termination. Similarly, continuation treatment with either cognitive therapy or perhaps interpersonal psychotherapy appears to reduce risk for relapse and maintenance treatment appears to reduce risk for recurrence. Preventive relapse strategies like preventive cognitive therapy or mindfulness based cognitive therapy (MBCT) applied to patients in remission protects against subsequent relapse and perhaps recurrence. There is some preliminary evidence of specific mediation via changing the content or the process of cognition. Continuation CT and preventive interventions started after remission (CBT, MBCT) seem to have the largest differential effects for individuals that need them the most. Those who have the greatest risk for relapse and recurrence including patients with unstable remission, more previous episodes, potentially childhood trauma, early age of onset. These prescriptive indications, if confirmed in future research, may point the way to personalizing prevention strategies. Doing so, may maximize the efficiency with which they are applied and have the potential to target the mechanisms that appear to underlie these effects. This may help make this prevention strategies more efficacious.

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“…These systems make it easier for patients and clinicians to notice changes in conditions over time, be it behavioral changes such as activity or medication, or psychopathological symptoms (eg, mood and sleep). Using these systems, worsening of the condition can be acted upon by patients and clinicians in collaboration, via comonitoring [13]. In general, data entered in these systems are graphically presented to enable patients and researchers/clinicians to visualize relationships between the entered data and development of the measured variables over time.…”

Section: Introductionmentioning

confidence: 99%

Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards

et al. 2017

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BackgroundPatients suffering from depression have a high risk of relapse and readmission in the weeks following discharge from inpatient wards. Electronic self-monitoring systems that offer patient-communication features are now available to offer daily support to patients, but the usability, acceptability, and adherence to these systems has only been sparsely investigated.ObjectiveWe aim to test the usability, acceptability, adherence, and clinical outcome of a newly developed computer-based electronic self-assessment system (the Daybuilder system) in patients suffering from depression, in the period from discharge until commencing outpatient treatment in the Intensive Outpatient Unit for Affective Disorders.MethodsPatients suffering from unipolar major depression that were referred from inpatient wards to an intensive outpatient unit were included in this study before their discharge, and were followed for four weeks. User satisfaction was assessed using semiqualitative questionnaires and the System Usability Scale (SUS). Patients were interviewed at baseline and at endpoint with the Hamilton depression rating scale (HAM-D17), the Major Depression Inventory (MDI), and the 5-item World Health Organization Well-Being Index (WHO-5). In this four-week period patients used the Daybuilder system to self-monitor mood, sleep, activity, and medication adherence on a daily basis. The system displayed a graphical representation of the data that was simultaneously displayed to patients and clinicians. Patients were phoned weekly to discuss their data entries. The primary outcomes were usability, acceptability, and adherence to the system. The secondary outcomes were changes in: the electronically self-assessed mood, sleep, and activity scores; and scores from the HAM-D17, MDI, and WHO-5 scales.ResultsIn total, 76% of enrolled patients (34/45) completed the four-week study. Five patients were readmitted due to relapse. The 34 patients that completed the study entered data for mood on 93.8% of the days (872/930), sleep on 89.8% of the days (835/930), activity on 85.6% of the days (796/930), and medication on 88.0 % of the days (818/930). SUS scores were 86.2 (standard deviation [SD] 9.7) and 79% of the patients (27/34) found that the system lived up to their expectations. A significant improvement in depression severity was found on the HAM-D17 from 18.0 (SD 6.5) to 13.3 (SD 7.3; P<.01), on the MDI from 27.1 (SD 13.1) to 22.1 (SD 12.7; P=.006), and in quality of life on the WHO-5 from 31.3 (SD 22.9) to 43.4 (SD 22.1; P<.001) scales, but not on self-assessed mood (P=.08). Mood and sleep parameters were highly variable from day-to-day. Sleep-offset was significantly delayed from baseline, averaging 48 minutes (standard error 12 minutes; P<.001). Furthermore, when estimating delay of sleep-onset (with sleep quality included in the model) during the study period, this showed a significant negative effect on mood (P=.03)ConclusionsThe Daybuilder systems performed well technically, and patients were satisfied with the system and h...

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Supportive monitoring and disease management through the internet: An internet-delivered intervention strategy for recurrent depression

Cited by 20 publications

References 44 publications

Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence

Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards

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