Change search
ReferencesLink to record
Permanent link

Direct link
Managing depression via the Internet: self-report measures, treatment & relapse prevention
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-9500-7763
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cognitive behaviour therapy (CBT) is an effective treatment for depression but access is limited. One way of increasing access is to offer CBT via the Internet. In Study I, guided Internet-based CBT was found to have a large effect on depressive symptoms compared to taking part in an online discussion group. Approximately two hours were spent on guiding each patient and the large effect found differs from previous studies that showed smaller effects, probably due to lack of guidance. The intervention had no effect on the participants’ quality of life but significantly decreased their level of anxiety.

Internet-based versions of self-report measures can be more practical and efficient than paper versions. However, before implementation, evidence of psychometrical equivalence to the paper versions should be available. This was tested in Studies II and III for the Montgomery-Åsberg Depression Rating Scale – Self-rated (MADRS-S) and the Beck Depression Inventory – Second Edition (BDI-II). When the full scales were investigated, equivalent psychometric properties were found in the two versions of the MADRS-S and BDI-II. However, in the Internet-version of the BDI-II, a lower score was found for the question about suicidality and the difference was statistically significant. Although the difference was small, this indicates that suicidality might be underestimated when using the Internet-based BDI-II.

As the long-term prognosis after treatment for depression is poor, in Study IV we investigated the possibility of delivering CBT-based relapse prevention via the Internet. The results revealed that fewer participants in the intervention group experienced a relapse compared to the control group and that the time spent on guiding each participant was approximately 2.5 hours. A trend towards a higher remission rate was found in the CBT group at the six-month follow-up and a reduction of depressive symptoms was associated with a lowered risk of relapse. CBT-based relapse prevention via the Internet can potentially be made available to large numbers of patients, thus improving their prognosis.

The Internet increases the possibilities for health care providers in the management of depression.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2011. , 88 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 56
Keyword [en]
Internet, depression, cognitive behaviour therapy, self-report measures, relapse prevention
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-15734ISBN: 978-91-7668-806-9OAI: oai:DiVA.org:oru-15734DiVA: diva2:419699
Public defence
2011-09-23, Örebro universitet, Prismahuset, Hörsal P2, Fakultetsgatan 1, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2016-08-10Bibliographically approved
List of papers
1. Internet-based self-help for depression: randomised controlled trial
Open this publication in new window or tab >>Internet-based self-help for depression: randomised controlled trial
Show others...
2005 (English)In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 187, 456-461 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Major depression can be treated by means of cognitive-behavioural therapy, but as skilled therapists are in short supply there is a need for self-help approaches. Many individuals with depression use the internet for discussion of symptoms and to share their experience.

AIMS:

To investigate the effects of an internet-administered self-help programme including participation in a monitored, web-based discussion group, compared with participation in web-based discussion group only.

METHOD:

A randomised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact (plus participation in a discussion group) with the effects of participation in a discussion group only.

RESULTS:

Internet-based therapy with minimal therapist contact, combined with activity in a discussion group, resulted in greater reductions of depressive symptoms compared with activity in a discussion group only (waiting-list control group). At 6 months' follow-up, improvement was maintained to a large extent.

CONCLUSIONS:

Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression.

Keyword
Adult, Cognitive Therapy/*methods, Depressive Disorder/*therapy, Female, Follow-Up Studies, Humans, Internet, Male, Middle Aged, Patient Compliance, Psychiatric Status Rating Scales, Self Care/*methods, Self-Help Groups, Telemedicine/*methods, Treatment Outcome
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3578 (URN)10.1192/bjp.187.5.456 (DOI)16260822 (PubMedID)
Available from: 2008-12-09 Created: 2008-12-09 Last updated: 2016-08-10Bibliographically approved
2. Can the BDI-II and MADRS-S be transferred to online use without affecting their psychometric properties?
Open this publication in new window or tab >>Can the BDI-II and MADRS-S be transferred to online use without affecting their psychometric properties?
2008 (English)In: Electronic Journal of Applied Psychology, Vol. 4, no 2, 63-65 p.Article in journal (Refereed) Published
Abstract [en]

The Internet has brought new possibilities to psychological assessment. Although there are several advantages to online assessment, there are also challenges. The aim of this study is to test the psychometric equivalence of the traditional paper versions and Internet adapted versions of the BDI-II and the MADRS-S. The 71 participants were recruited at a university campus, and filled out the BDI-II and MADRS-S on both Internet and paper. They were randomized to complete either the Internet versions or the paper versions first, and then complete the other version on the next day. For both the BDI-II and the MADRS-S the Chronbach’s alpha levels were similar in the two mediums of administration. No significant differences were found between the paper versions and the Internet versions and the scores from the two differing mediums correlated highly for both questionnaires. Therefore, it was concluded that the psychometric properties of the BDI-II and the MADRS-S remained unchanged after transformation to online use.

Keyword
Internet, questionnaires
National Category
Psychiatry
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-16409 (URN)
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2016-08-10Bibliographically approved
3. A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients
Open this publication in new window or tab >>A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients
2010 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, Vol. 12, no 5, e49- p.Article in journal (Refereed) Published
Abstract [en]

Background:

Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes. However, many clinicians do not use self-report measures systematically in their clinical practice. Internet-based questionnaires could facilitate administration, but the psychometric properties of the online version of an instrument should be explored before implementation. The recommendation from the International Test Commission is to test the psychometric properties of each questionnaire separately.

Objective:

Our objective was to compare the psychometric properties of paper-and-pencil versions and Internet versions of two questionnaires measuring depressive symptoms.

Methods:

The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden. Participants completed the Beck Depression Inventory (BDI-II) and the Montgomery- Åsberg Depression Rating Scale—Self-rated (MADRS-S), both on paper and on the Internet. The order was randomized to control for order effects. Symptom severity in the sample ranged from mild to severe depressive symptoms.

Results:

Psychometric properties of the two administration formats were mostly equivalent. The internal consistency was similar for the Internet and paper versions, and significant correlations were found between the formats for both MADRS-S (r= .84) and the BDI-II (r= .89). Differences between paper and Internet total scores were not statistically significant for either questionnaire nor for the MADRS-S question dealing with suicidality (item 9) when analyzed separately. The score on the BDI-II question about suicidality (item 9) was significantly lower when administered via the Internet compared with the paper score, but the difference was small (effect size, Cohen’s [d] = 0.14). There were significant main effects for order of administration on both questionnaires and significant interaction effects between format and order. This should not, however, pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made.

Conclusions:

The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinically meaningful way. The full BDI-II also seems to retain its properties when transferred; however, the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study. The use of online questionnaires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save resources.

Keyword
Questionnaires, psychometrics, Internet, depression
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-16410 (URN)10.2196/jmir.1392 (DOI)21169165 (PubMedID)
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2016-08-10Bibliographically approved
4. Randomized trial of Internet-based relapse prevention for partially remitted depression
Open this publication in new window or tab >>Randomized trial of Internet-based relapse prevention for partially remitted depression
Show others...
2011 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, no 4, 285-294 p.Article in journal (Refereed) Published
Abstract [en]

Objective:

To investigate whether Internet-based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment.

Method:

Seventy-one women and 13 men (N= 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet-based CBT or to a control group. Self-help material was used in combination with e-mail contact with a personal therapist. Monthly self-ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later.

Results:

Significantly fewer participants in the CBT group experienced relapse (4⁄38 or 10.5%) compared with those in the control group (14⁄37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post-treatment in the participants who received CBT compared with controls. Reduction in depressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow-up.

Conclusion:

Internet-based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.

Keyword
Depression, Internet, Relapse prevention
National Category
Psychiatry
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-16408 (URN)10.1111/j.1600-0447.2011.01698.x (DOI)
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2016-08-10Bibliographically approved

Open Access in DiVA

fulltext(1482 kB)1191 downloads
File information
File name FULLTEXT02.pdfFile size 1482 kBChecksum SHA-512
eebc6c9862665f364a25144b34b0d479ddfe0af96f7710dcedac702f069dc5ebf384c812d704be44c8d668ee0f5a6aff6f0c206e77d4390f4330f88bb1482c43
Type fulltextMimetype application/pdf
omslag(1684 kB)62 downloads
File information
File name COVER01.pdfFile size 1684 kBChecksum SHA-512
46a484b388264c8409c3b8073274f99513a45d02a69ca550270bed3aa137d68774745e2b9b344de0b1ad9b418339b4becd5b4ac869a9c4dc8062fe9fb9c99271
Type coverMimetype application/pdf
spikblad(48 kB)15 downloads
File information
File name SPIKBLAD01.pdfFile size 48 kBChecksum SHA-512
97e798ecb5cd3f8c558711e777c866b2dfc83c959d15fc0e1aa21ed1324e439902473c0b55596bf2e0d75516708730dadc60ed8e6dec4682a9cfec8c3a9a1374
Type spikbladMimetype application/pdf

Search in DiVA

By author/editor
Holländare, Fredrik
By organisation
School of Health and Medical Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 1191 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 1144 hits
ReferencesLink to record
Permanent link

Direct link