Newby Jill, Robins Lisa, Wilhelm Kay, Smith Jessica, Fletcher Therese, Gillis Inika, Ma Trevor, Finch Adam, Campbell Lesley, Andrews Gavin
School of Psychology, The University of New South Wales, Randwick, Australia.
The University of New South Wales at St Vincent's Hospital, Clinical Research Unit for Anxiety and Depression, School of Psychiatry, Darlinghurst, Australia.
J Med Internet Res. 2017 May 15;19(5):e157. doi: 10.2196/jmir.7274.
Depression is twice as common in diabetes mellitus (DM) as the general population and is associated with adverse health outcomes, but access to evidence-based therapies such as cognitive behavioral therapy (CBT) is limited in routine diabetes care. Past research has shown that generic Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for depression in the general population, but it has never been evaluated in people with comorbid depression and DM.
The aim of our study was to examine the efficacy of a generic 6-lesson iCBT delivered over 10 weeks in people with major depressive disorder (MDD) and DM.
Participants with comorbid MDD and DM (type 1 or 2) were recruited online and randomized to an iCBT program with therapist support provided by phone and email (n=42) or a treatment as usual (TAU, n=49) control group. Outcomes were assessed through Web-based self-report questionnaires and the trial was Web-based with no face-to-face components. Primary outcomes were self-reported depression (patient health questionnaire-9, PHQ-9), diabetes-related distress (problem areas in diabetes, PAID), and self-reported glycemic control (hemoglobin A1c, HbA1c). Secondary outcomes were general distress (Kessler 10-item psychological distress scale, K-10) and disability (short form 12-item, SF-12), generalized anxiety (generalized anxiety disorder 7-item, GAD-7), and somatization (PHQ-15). The iCBT group was assessed at 3 months.
A total of 27 participants (66%; 27/41) completed the iCBT program. Analyses indicated between-group superiority of iCBT over TAU at posttreatment on PHQ-9 (g=0.78), PAID (g=0.80), K-10 (g=1.06), GAD-7 (g=0.72), and SF-12 mental well-being scores (g=0.66), but no significant differences in self-reported HbA1c levels (g=0.14), SF-12 physical well-being, or PHQ-15 scores (g=0.03-0.21). Gains were maintained at 3-month follow-up in the iCBT group, and the 87% (27/31) of iCBT participants who were interviewed no longer met criteria for MDD. Clinically significant change following iCBT on PHQ-9 scores was 51% (21/41) versus 18% (9/49) in TAU.
iCBT for depression is an efficacious, accessible treatment option for people with diabetes. Future studies should explore whether tailoring of iCBT programs improves acceptability and adherence, and evaluate the long-term outcomes following iCBT.
Australian and New Zealand Clinical Trials Registry (ACTRN): 12613001198718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365208&isReview=true (Archived by WebCite at http://www.webcitation.org/6qCR8Fi9V).
抑郁症在糖尿病患者中的发病率是普通人群的两倍，且与不良健康结局相关，但在常规糖尿病护理中，获得认知行为疗法（CBT）等循证疗法的机会有限。过去的研究表明，基于互联网的通用认知行为疗法（iCBT）是治疗普通人群抑郁症的有效方法，但从未在合并抑郁症和糖尿病的患者中进行过评估。
我们研究的目的是检验为期10周、共6节的通用iCBT对重度抑郁症（MDD）合并糖尿病患者的疗效。
通过网络招募MDD合并糖尿病（1型或2型）患者，并将其随机分为iCBT组（n = 42）和常规治疗（TAU，n = 49）对照组，iCBT组通过电话和电子邮件获得治疗师的支持。通过基于网络的自我报告问卷评估结果，该试验基于网络，无面对面环节。主要结局指标为自我报告的抑郁症状（患者健康问卷-9，PHQ-9）、糖尿病相关痛苦（糖尿病问题领域，PAID）和自我报告的血糖控制情况（糖化血红蛋白，HbA1c）。次要结局指标为一般痛苦（凯斯勒10项心理痛苦量表，K-10）、残疾情况（简短健康调查问卷12项，SF-12）、广泛性焦虑（广泛性焦虑障碍7项，GAD-7）和躯体化症状（PHQ-15）。iCBT组在3个月时进行评估。
共有27名参与者（66%；27/41）完成了iCBT项目。分析表明，在治疗后，iCBT组在PHQ-9（g = 0.78）、PAID（g = 0.80）、K-10（g = 1.06）、GAD-7（g = 0.72）和SF-12心理健康评分（g = 0.66）方面优于TAU组，但在自我报告的HbA1c水平（g = 0.14）、SF-12身体健康状况或PHQ-15评分（g = 0.03 - 0.21）方面无显著差异。iCBT组在3个月随访时维持了治疗效果，接受访谈的iCBT参与者中有87%（27/31）不再符合MDD的诊断标准。iCBT治疗后PHQ-9评分有临床意义的变化为51%（21/41），而TAU组为18%（9/49）。
iCBT治疗抑郁症对糖尿病患者是一种有效且可及的治疗选择。未来的研究应探索iCBT项目的个性化定制是否能提高可接受性和依从性，并评估iCBT后的长期结局。
澳大利亚和新西兰临床试验注册中心（ACTRN）：12613001198718；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365208&isReview=true（由WebCite存档于http://www.webcitation.org/6qCR8Fi9V）
