Self-guided web-based intervention may help prevent onset of depression

1. Patients at risk for depression showed reduced incidence of Major Depressive Disorder (MDD) while using a self-guided web-based therapeutic module compared to those receiving usual care.

2. Patients in the intervention group had improved scores on many depression and anxiety scales compared to the usual care group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Major Depressive Disorder (MDD) is one of the major contributors to disability adjusted life years lost across the globe. Though advances in treatment of MDD are still necessary, a greater emphasis on prevention may be a viable strategy for reducing both the burden and cost of the disease. In this randomized controlled trial, patients with sub-threshold depression or those at risk for MDD were randomly assigned to receive a web-based series of self-guided modules or care as usual, which consisted of visits to the primary care physician. The patients in the web-based intervention group had a lower rate of developing MDD, with the number needed to treat being roughly 1 in 6. In addition, those who did develop MDD did so later into the study period than those receiving standard care, and had better scores on a number of clinical depression and anxiety scales. Because the health and economic burden of MDD remains so high, novel interventions like the one presented in this study may find significant utility in the future of clinical medicine. While the results of this study are promising, larger cohorts will be needed to assess the overall impact of these interventions on health care outcomes and spending, and define which subpopulations benefit most from these interventions.

Click to read the study in JAMA

Relevant Reading: Minimal-contact psychotherapy for sub-threshold depression in primary care

In-Depth [randomized controlled trial]: Participants at high risk for MDD, as assessed using a clinical scale, were recruited to this study. In total, 406 participants were randomly assigned to receive a 6 session web-based self-guided module or to a control group receiving usual primary care. Of these, 82% completed the 6- and 12-month follow up interviews. The intervention group demonstrated a lower incidence of MDD (p = 0.003) compared to the control group. Additionally, the time to development of MDD was increased in patients receiving the web-based modules (p = 0.002). The estimated number needed to treat was 5.9 (95%CI 3.9 – 14.6), and controlling for antidepressant-use did not change these results. Patients who received the intervention also had significantly improved scores on most of the depression and anxiety scales, with no differences seen in the scales of physical health, positive problem-orientation, and worrying. There were no significant differences in health care use, such as psychiatry and psychology visits or antidepressant use.

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