Departamento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, Spain.
BMC Psychiatry. 2013 Jan 11;13:21. doi: 10.1186/1471-244X-13-21.
Major depression will become the second most important cause of disability in 2020. Computerized cognitive-behaviour therapy could be an efficacious and cost-effective option for its treatment. No studies on cost-effectiveness of low intensity vs self-guided psychotherapy has been carried out. The aim of this study is to assess the efficacy of low intensity vs self-guided psychotherapy for major depression in the Spanish health system.
The study is made up of 3 phases: 1.- Development of a computerized cognitive-behaviour therapy for depression tailored to Spanish health system. 2.- Multicenter controlled, randomized study: A sample (N=450 patients) with mild/moderate depression recruited in primary care. They should have internet availability at home, not receive any previous psychological treatment, and not suffer from any other severe somatic or psychological disorder. They will be allocated to one of 3 treatments: a) Low intensity Internet-delivered psychotherapy + improved treatment as usual (ITAU) by GP, b) Self-guided Internet-delivered psychotherapy + ITAU or c) ITAU. Patients will be diagnosed with MINI psychiatric interview. Main outcome variable will be Beck Depression Inventory. It will be also administered EuroQol 5D (quality of life) and Client Service Receipt Inventory (consume of health and social services). Patients will be assessed at baseline, 3 and 12 months. An intention to treat and a per protocol analysis will be performed.
The comparisons between low intensity and self-guided are infrequent, and also a comparative economic evaluation between them and compared with usual treatment in primary. The strength of the study is that it is a multicenter, randomized, controlled trial of low intensity and self-guided Internet-delivered psychotherapy for depression in primary care, being the treatment completely integrated in primary care setting.
Clinical Trials NCT01611818.
到 2020 年，重度抑郁症将成为第二大致残原因。计算机化认知行为疗法可能是一种有效且具有成本效益的治疗选择。目前尚未开展针对低强度与自我指导心理治疗的成本效益比较研究。本研究旨在评估在西班牙卫生系统中，低强度与自我指导心理治疗对重度抑郁症的疗效。
该研究分为 3 个阶段：1. 为西班牙卫生系统定制计算机化认知行为疗法治疗抑郁症。2. 多中心对照、随机研究：在初级保健中招募轻度/中度抑郁的患者（n=450）。他们应该在家里可以上网，没有接受过任何先前的心理治疗，也没有患有任何其他严重的躯体或心理障碍。他们将被分配到以下 3 种治疗方法之一：a）低强度互联网心理治疗+GP 的改进常规治疗（ITAU），b）自我指导互联网心理治疗+ITAU 或 c）ITAU。患者将通过 MINI 精神病学访谈进行诊断。主要结局变量为贝克抑郁量表。还将评估欧洲五维健康量表（生活质量）和客户服务接受度清单（卫生和社会服务的使用情况）。患者将在基线、3 个月和 12 个月进行评估。将进行意向治疗和方案分析。
低强度与自我指导的比较很少见，而且它们与常规治疗在初级保健中的比较也很少进行经济评估。该研究的优势在于，它是一项在初级保健中对低强度和自我指导的互联网心理治疗重度抑郁症的多中心、随机、对照试验，该治疗完全整合到初级保健环境中。
临床试验 NCT01611818。
