Depression Clinical Trial
Official title:
Adherence to the iFightDepression Online Self-help Tool for Mild and Moderate Depression
Background Computerized cognitive behavioural therapy (cCBT) is proven to be an effective
self-help tool for preventing depression and suicide. Patient adherence is one of the
components that the effectiveness of cCBT self-help tools are dependent on and that needs to
be researched for understanding and maximizing the effectiveness of computer-based
interventions for depression and suicide.
Aims The aims of this study were to compare the adherence of iFightDepression (iFD) online
tool user patients with and without an extra weekly phone call consultation and to test
predictors of adherence.
Depressive disorders are recognized as one of the most widespread lifetime disorders and
unipolar depression is identified as a leading cause of disease burden . These findings
legitimate the importance of reducing depressive symptoms by implementing cost-effective
interventions. Despite the fact that cognitive behaviour therapy (CBT) is proved to be an
efficient treatment for depression, mental health care resources are scarce and cannot fulfil
the huge amount of need for face-to-face psychotherapeutic treatments. The aim of
increasingly deploying computerized cognitive behavioural therapy (cCBT) is to improve access
to psychological treatments, reduce waiting lists, speed up clinical recovery and to bridge
the paucity of specialists in small towns. Moreover, guided web-based self-help interventions
are proved to be cost-effective and time-saving for mental health care systems as well.
Numerous studies have proved the cCBT to be effective in case of depression, however drop-out
rates of online self-help interventions are usually high - between 5 and 38.7%. Systematic
reviews showed that in web-based self-help treatments extra support obtains higher adherence
than no guidance. Treatment-adherence, defined as the amount of a therapeutic intervention
that an individual engages with or completes, has clear clinical implications: poor adherence
limits the exposure to the full program and increases the required 'dosage' of treatment.
In the comparison of drop-out rates of different psychological treatments, no difference has
been found between face-to-face and web-based interventions. Previous research has found that
the drop-out risk from cCBT is significantly correlated with gender, educational level and
age. Increased drop-out risk included male gender, younger age and lower educational level.
This finding has been proved in another research as well, where females have been found to
provide more effort to cope with depression compared to males.
With regard to adherence, a low educational level might negatively influence the adherence to
cCBT as understanding the content of intervention can be troublesome. Results from previous
studies suggested that younger individuals had higher adherence to web-based treatment,
whilst some other studies showed that younger age was related to low treatment adherence.
Several findings also suggested that additional forms of guidance or support via phone or
email increase the level of adherence. In order to offer web-based treatment to patients with
the most benefits, it would be useful to identify the predictors of treatment adherence and
causes of the relatively high dropout rate.
Insomnia is one of the main symptoms of depression. Studies show insomnia to be one of the
risk factors such for development of depression as for reducing response to depression
treatment and increasing relapse of depression. Therefore, to quest a correlation between
adherence in an online self-help program for depression and sleep disturbances would be
subservient.
Our goal in this study was to identify predictors of adherence to a computerized CBT program
and to investigate whether sociodemographic variables, hopelessness and sleep disturbances
are connected to adherence. Another objective was to compare adherence in web-based self-help
intervention with and without weekly follow-up phone-calls as extra support. Our hypothesis
was that phone-support would increase adherence level of cCBT.
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