Background older people coping with the impacts of living with multimorbidity are at increased risk of developing a depressive disorder. Objective this article reports the 24-month results of a randomised controlled trial of an internet-delivered cognitive behaviour therapy, which aimed to test whether depressive disorders could be prevented in this population. Participants community-based participants aged 65 years and over, who had two or more chronic physical health conditions and were assessed as having no current depressive disorder. Methods in total, 302 participants were randomised to an 8-week, five-lesson, internet-delivered intervention program (n = 150) or treatment as usual (TAU, n = 152). The primary outcomes were cases of depressive disorder, assessed post-intervention and at 3-month intervals throughout the trial, and depressive symptoms, assessed at pre-intervention, post-intervention, 6, 12 and 24 months following the intervention. Results there were significantly fewer cases of depressive disorder in the intervention group (n = 23, 15%) compared with the TAU group (n = 41, 27%) during the 24 months after the intervention (χ2(1, N = 302) = 6.13, P = 0.013, odds ratio = 0.490 [95% confidence interval: 0.277, 0.867]), representing a 44% reduction in cases of depressive disorder. No differences were found on depressive symptoms at 24-month follow-up. Internet-delivered cognitive behaviour therapy had high engagement and acceptability. Conclusions the results provide support that depressive disorders can be prevented in older people with multimorbidity through participation in internet-delivered cognitive behaviour therapy. With access to internet-delivered interventions in clinical care settings increasing, this has implications for older patient care where multimorbidity is extremely common.

中文翻译：

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预防患有多种疾病的老年人的抑郁症：互联网认知行为疗法试验的 24 个月随访

背景 应对患有多种疾病的影响的老年人患抑郁症的风险增加。目的 本文报告了一项为期 24 个月的互联网认知行为疗法随机对照试验的结果，该试验旨在测试是否可以在该人群中预防抑郁症。参与者 年龄在 65 岁及以上的社区参与者，他们有两种或两种以上的慢性身体健康状况，并且被评估为目前没有抑郁症。方法总共有 302 名参与者被随机分配到一个为期 8 周、5 节课的互联网干预计划（n = 150）或照常治疗（TAU，n = 152）。主要结局是抑郁症病例，在整个试验期间以干预后和每 3 个月的时间间隔进行评估，在干预前、干预后、干预后 6、12 和 24 个月评估抑郁症状。结果在干预后的 24 个月内，干预组（n = 23, 15%）的抑郁症病例显着少于 TAU 组（n = 41, 27%）（χ2（1, N = 302） = 6.13，P = 0.013，优势比 = 0.490 [95% 置信区间：0.277, 0.867]），表示抑郁症病例减少了 44%。在 24 个月的随访中没有发现抑郁症状的差异。互联网提供的认知行为疗法具有很高的参与度和可接受性。结论结果支持通过参与互联网提供的认知行为治疗，可以预防患有多种疾病的老年人的抑郁症。