Feasibility, effectiveness and safety of the self-management intervention deprexis in routine medical care: Results of an uncontrolled observational study.,Internet Interventions

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Feasibility, effectiveness and safety of the self-management intervention deprexis in routine medical care: Results of an uncontrolled observational study.
Internet Interventions ( IF 3.6 ) Pub Date : 2020-08-27 , DOI: 10.1016/j.invent.2020.100341
Jan Philipp Klein ₁ , Bettina Barthel ₂ , Thomas Berger ₃ , Steffen Moritz ₄

Affiliation

Introduction

Numerous RCTs have demonstrated the effectiveness of internet-based self-management interventions (SMIs) in the treatment of depressive symptoms. These studíes often recruit outside routine clinical practice. For the present study, we investigated the feasibility, effectiveness and safety of an SMI (deprexis) in routine medical care using a non-interventional design.

Methods

A total of 104 patients with a depressive disorder (60.58% female, mean age 45.82 yrs) were recruited in 25 outpatient practices in Germany (mostly psychiatric practices, n = 16). They received 12 week access to the SMI in addition to their usual care (76.0% took concomitant antidepressant medication). Guidance could optionally be offered by the treating physician. The effectiveness of the intervention was assessed using the clinician-rated short version of the Montgomery Asberg-Depression Scale (svMADRS) and the Patient Health Questionnaire (PHQ-9), a self-rating for depressive symptoms. Outcomes were assessed at baseline as well as at weeks 3, 6, 9 and 12.

Results

Most patients reported using the intervention at least once (n = 87, 83.6%), among these users the mean number of sessions was 18.05 (SD = 11.33). Only a minority of patients received the guided version of the intervention (n = 7, 8.0%). The severity of depressive symptoms decreased significantly over the observation period from 29.72 (SD = 10.03) to 15.73 (SD = 9.74) for the svMADRS (Cohen's d = 1.42, 95% CI 0.08–2.76) and from 15.20 (SD = 5.03) to 8.77 (SD = 5.03) for the PHQ-9 (d = 1.29, 95% CI 0.60–1.97).

Discussion

The size of the pre-post effect on depressive symptoms observed in this study is comparable to the pre-post effect size reported in an RCT using the same intervention in patients suffering from depressive symptoms of the same severity. Limitations of this study include the lack of a control group and the fact that the recruitment rate was far lower than expected.

Conclusion

This non-interventional study conducted in outpatient practices confirms results from numerous RCTs. Taken together, these data show that deprexis can be used effectively and safely in the routine care of depressed outpatients.

中文翻译：

常规医疗中自我管理干预的可行性、有效性和安全性：一项非对照观察研究的结果。

介绍

许多随机对照试验证明了基于互联网的自我管理干预 (SMI) 在治疗抑郁症状方面的有效性。这些研究经常在常规临床实践之外招募。对于本研究，我们使用非介入性设计调查了 SMI（deprexis）在常规医疗护理中的可行性、有效性和安全性。

方法

共有 104 名抑郁症患者（60.58% 为女性，平均年龄 45.82 岁）在德国的 25 家门诊诊所（主要是精神科诊所，n = 16）中招募。除了常规护理外，他们还接受了 12 周的 SMI 治疗（76.0% 的人同时服用了抗抑郁药物）。可以选择由治疗医师提供指导。使用临床医生评定的蒙哥马利阿斯伯格抑郁量表 (svMADRS) 和患者健康问卷 (PHQ-9) 评估干预的有效性，这是对抑郁症状的自我评定。在基线以及第 3、6、9 和 12 周评估结果。

结果

大多数患者报告至少使用过一次干预（n = 87, 83.6%），在这些用户中，平均会话数为 18.05（SD = 11.33）。只有少数患者接受了指导版本的干预（n = 7, 8.0%）。svMADRS (Cohen's d = 1.42, 95% CI 0.08–2.76) 和从 15.20 (SD = 5.03) 到 15.72 (SD = 10.03) 到 15.73 (SD = 9.74) PHQ-9 为 8.77 (SD = 5.03) (d = 1.29, 95% CI 0.60–1.97)。