Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial

Language
en
Document Type
Article
Issue Date
2020-03-26
Issue Year
2019
Authors
Schlicker, Sandra
Weisel, Kiona K.
Buntrock, Claudia
Berking, Matthias
Nobis, Stephanie
Lehr, Dirk
Baumeister, Harald
Snoek, Frank J.
Riper, Heleen
Ebert, David D.
Editor
Publisher
Hindawi
Abstract

Introduction. Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Methods. Randomized controlled trial- (RCT-) based data () comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (; ). Results. Major depressive disorder diagnosis at the baseline (), higher levels of depression (Beck Depression Inventory II; ; ), and lower HbA1c () predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (; 95% CI: 0.001-1.83), with a between-group effect size of (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; ; ). At the 6-month follow-up, effects were maintained for depressive symptom reduction (; 95% CI: 0.19-1.61) but not treatment response. Conclusion. Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.

Journal Title
Journal of Diabetes Research
Volume
2019
Citation
Journal of Diabetes Research 2019 (2019). <https://www.hindawi.com/journals/jdr/2019/2634094/>