Lüdtke Thies, Westermann Stefan, Pult Lilian K, Schneider Brooke C, Pfuhl Gerit, Moritz Steffen
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.
Internet Interv. 2018 Jun 28;13:73-81. doi: 10.1016/j.invent.2018.06.004. eCollection 2018 Sep.
Psychological online interventions (POIs) reduce depression but we know little about factors influencing their effectiveness. We evaluated a new, brief POI for depression and conducted exploratory moderator analyses.
In this online trial (German Clinical Trials Register; DRKS00011045), we allocated participants to treatment as usual (TAU; = 67) or POI ( = 65). At first, we randomized participants; later we allocated participants based on depression severity in order to counter baseline differences. The unguided POI addressed behavioral activation and depressive thinking in a single module with 25 webpages (including a smartphone application). We did one assessment at baseline and a post-assessment four weeks later.
At post-assessment, depression ( = .586), behavioral activation ( = .332), and dysfunctional attitudes ( = .499) did not differ between groups. When concurrent treatments (medication/psychotherapy) remained constant/decreased, the POI outperformed TAU ( = .031). POI-participants with lower willingness to change ( = .030) or higher education ( = .017) were less likely to worsen (i.e., experience increased depressive symptoms) compared to TAU.
The targeted sample size was not reached, measurements were self-reported, and randomization failed. The POI's content may have been too limited. Concurrent treatments, which were more often sought out by TAU participants, diminished group differences and should be considered in future studies. Brief POIs may protect against worsening of depressive symptoms among highly educated participants or those with low willingness to change.
在线心理干预措施（POIs）可减轻抑郁症状，但我们对影响其有效性的因素知之甚少。我们评估了一种新型的、简短的抑郁症在线心理干预措施，并进行了探索性调节分析。
在这项在线试验（德国临床试验注册中心；DRKS00011045）中，我们将参与者分配至常规治疗组（TAU； = 67）或在线心理干预组（ = 65）。起初，我们对参与者进行随机分组；之后，我们根据抑郁严重程度进行分配，以应对基线差异。非指导性在线心理干预措施在一个包含25个网页（包括一个智能手机应用程序）的单一模块中涉及行为激活和抑郁思维。我们在基线时进行了一次评估，并在四周后进行了一次评估。
在评估后，两组之间的抑郁（ = 0.586）、行为激活（ = 0.332）和功能失调态度（ = 0.499）没有差异。当同时进行的治疗（药物/心理治疗）保持不变/减少时，在线心理干预措施的效果优于常规治疗组（ = 0.031）。与常规治疗组相比，改变意愿较低（ = 0.030）或教育程度较高（ = 0.017）的在线心理干预组参与者病情恶化的可能性较小（即抑郁症状增加）。
未达到目标样本量，测量为自我报告，随机分组失败。在线心理干预措施的内容可能过于有限。常规治疗组参与者更常寻求的同时进行的治疗减少了组间差异，未来研究应予以考虑。简短的在线心理干预措施可能预防高学历参与者或改变意愿低的参与者的抑郁症状恶化。
