Background: Internet- and mobile-based interventions are most efficacious in the treatment of depression when they involve some form of guidance, but providing guidance requires resources such as trained personnel, who might not always be available (eg, during lockdowns to contain the COVID-19 pandemic). Objective: The current analysis focuses on changes in symptoms of depression in a guided sample of patients with depression who registered for an internet-based intervention, the iFightDepression tool, as well as the extent of intervention use, compared to an unguided sample. The objective is to further understand the effects of guidance and adherence on the intervention’s potential to induce symptom change. Methods: Log data from two convenience samples in German routine care were used to assess symptom change after 6-9 weeks of intervention as well as minimal dose (finishing at least two workshops). A linear regression model with changes in Patient Health Questionnaire (PHQ-9) score as a dependent variable and guidance and minimal dose as well as their interaction as independent variables was specified. Results: Data from 1423 people with symptoms of depression (n=940 unguided, 66.1%) were included in the current analysis. In the linear regression model predicting symptom change, a significant interaction of guidance and minimal dose revealed a specifically greater improvement for patients who received guidance and also worked with the intervention content (β=–1.75, t=–2.37, P=.02), while there was little difference in symptom change due to guidance in the group that did not use the intervention. In this model, the main effect of guidance was only marginally significant (β=–.53, t=–1.78, P=.08). Conclusions: Guidance in internet-based interventions for depression is not only an important factor to facilitate adherence, but also seems to further improve results for patients adhering to the intervention compared to those who do the same but without guidance.

中文翻译：

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在 COVID-19 大流行期间使用无指导的基于互联网的认知行为疗法治疗抑郁症的干预使用和症状变化：便利样本的日志数据分析

背景：当涉及某种形式的指导时，基于互联网和移动的干预措施在治疗抑郁症方面最有效，但提供指导需要诸​​如训练有素的人员之类的资源，这些人员可能并不总是可用（例如，在封锁期间以遏制 COVID -19 大流行）。目标：当前的分析侧重于与非指导样本相比，在注册了基于互联网的干预、iFightDepression 工具的抑郁症患者的指导样本中抑郁症状的变化，以及干预使用的程度。目的是进一步了解指导和依从性对干预诱发症状变化的潜力的影响。方法：来自德国常规护理中的两个便利样本的日志数据用于评估干预 6-9 周以及最小剂量（至少完成两次研讨会）后的症状变化。将患者健康问卷 (PHQ-9) 得分变化作为因变量，并指定指导和最小剂量及其相互作用作为自变量的线性回归模型。结果：目前的分析包括来自 1423 名有抑郁症状的人（n=940 人，66.1%）的数据。在预测症状变化的线性回归模型中，指导和最小剂量的显着相互作用显示，对于接受指导并同时使用干预内容的患者，改善尤其显着（β =–1.75，t=–2.37, P =.02)，而在未使用干预的组中，由于指导而导致的症状变化几乎没有差异。在这个模型中，指导的主效应只是轻微显着（β =–.53，t =–1.78，P =.08）。结论：对基于互联网的抑郁症干预措施的指导不仅是促进依从性的重要因素，而且与那些坚持干预但没有指导的患者相比，似乎还可以进一步改善坚持干预的患者的结果。