A multisession intervention treating depressive symptoms in people with subthreshold depression to prevent major depression
GET.ON Mood Enhancer is a six-session intervention for preventing major depression in people with subthreshold depression. Sessions last about thirty minutes and focus on identifying meaningful aspects of life and manageable problems, brainstorming solutions to manageable problems, and accomplishing goals. Three optional sessions focus on sleep hygiene, relaxation, and worrying thoughts. Coaches send messages to users through the intervention website to support completion of the intervention. Users are assigned homework and have the option to receive text messages relating to the content of the intervention.
Problem Solving Therapy
Young Adults (18-30)
Effectiveness of a web-based cognitive behavioral intervention for subthreshold depression: Pragmatic randomized controlled trial
Summary: Researchers recruited 406 participants with depressive symptoms that do not meet the threshold for clinical diagnosis (subthreshold depression) from a German health insurance company, using advertisements. Participants were randomized to receive care as usual (CAU; usual primary care and psychoeducation, care for unipolar depression if symptoms worsen) and GET.ON Mood Enhancer or CAU and a web-based psychoeducational intervention with no homework assignments or coach. Participants in the intervention group were told to complete at least one session a week. The primary outcome was depressive symptom severity after the intervention and at a six-month follow-up, as assessed in online surveys. Overall, participants experienced significant improvements in depressive symptom severity; with greater improvement in the Intervention group. Participants in the intervention group were more likely to experience a positive change in their symptoms and reach close to symptom-free status than participants in the control group. Intervention completers had significantly better outcomes than non-completers. The intervention group maintained symptom severity scores between post-intervention and 6 months and the control group improved between post-intervention and 6 months. The intervention group still reported significantly better symptom severity than control. More participants in the intervention group still showed a treatment response at follow-up than in the control group.
Take Away: GET.ON Mood Enhancer shows the potential to improve depression symptom severity in people with subthreshold depression more than web-based psychoeducation intervention.
Effect of a web-based guided self-help intervention for prevention of major depression in adults with subthreshold depression: A randomized clinical trial
Summary: Twelve month outcomes for the randomized clinical trial were reported in this paper. The primary measures of interest were incidence of major depression and time to onset of major depression. Secondary outcomes included depressive symptom severity, functional impairment, anxiety, problem-solving skills, behavioral activation, mastery, worrying, insomnia severity, and health care service uptake. Incidence of major depression over the 12 months was significantly lower among participants who received the Intervention than those that received care as usual. Moreover, average time to onset of major depression disorder was shorter for the control group than for the intervention group. The intervention group scored significantly better than the control group on all secondary outcomes other than physical health (subscale of functional impairment), positive-problem orientation (subscale of problem-solving skills), and worrying.
Take Away: Participants who received GET.ON Mood Enhancer experienced sustained improvement in outcomes relative to those in the care as usual condition at 12 months post intervention.
Preventing depression in adults with subthreshold depression: Health-economic evaluation alongside a pragmatic randomized controlled trial of a web-based intervention
Summary: As a part of the randomized controlled trial, researchers conducted an economic evaluation of GET.ON Mood Enhancer from a societal (i.e. all costs incurred) and public health perspective (i.e. medical costs incurred) compared to enhanced CAU. Participants completed assessments of depression and quality of life at six- and 12-month follow-up and researchers used these assessments to calculate depression-free years and quality-adjusted life years (QALYs). Participants in the intervention group had more time before the onset of depression (43 weeks) than the control group (37 weeks), resulting in significantly more depression-free years in the intervention group (0.82) than in the control group (0.70). No difference was seen for QALYs. The cost of the intervention (€299) was greater than enhanced usual care (€10). From societal and public health care perspectives, greater increases in DFYs were experienced in the intervention group at greater costs than the control group. From a societal perspective, the intervention had a 38% chance of being cost effective (greater improvements at lower costs compared to control). From both perspectives, there were improvements of .01 QALYs. From a public health care perspective, there was a 17% chance using DFYs and a 16% using QALYs that the intervention would be cost-effective. Likelihoods that the intervention would be cost-effective rose as willingness to pay increased.
Take Away: GET.ON Mood Enhancer results in improved outcomes at greater costs and its cost-effectiveness depends on societal willingness to pay.
Effectiveness of web- and mobile-based treatment of subthreshold depression with adherence-focused guidance. A single-blind randomised controlled trial
Summary: In this pragmatic randomized controlled trial, researchers used referrals from a German health insurance company and advertisements to recruit 204 participants who screened positive for subthreshold depression and were not receiving psychotherapy. Participants were randomized to receive GET.ON Prevention, web-based guidance from a coach to promote intervention session completion, and the option to receive text messages supporting use of coping skills or to a waitlist control group. Researchers assessed clinician-rated depressive symptom severity, self-rated mental health (i.e. depression, anxiety, worrying, insomnia severity, and alcohol use disorders), and skills addressed in treatment (i.e. behavioral activation, problem-solving skills, mastery) at baseline, post-treatment (seven weeks), and 3 months follow-up. At post-treatment, the intervention and control groups experienced significant reduction in depressive symptom severity, but the intervention group had significantly lower depressive symptom severity. The intervention group reported significant improvements post-treatment in all other outcomes compared to control excluding mastery, negative problem-solving orientation, and alcohol disorders. Participants in the intervention group achieved a 50% reduction in depressive symptom severity scores. More participants in the intervention group than the control group met criteria for symptom-free status for depression. The intervention and control groups did not experience changes in depressive symptom severity between post-intervention and 3-month follow-up. The significantly lower depressive symptom severity in the intervention group compared to the control group remained at 3 months.
Take Away: This study supports GET.ON Mood Enhancer to reduce depressive symptoms and prevent major depression with limited support from professionals.