Effect of a Web-Based Guided Self-help Intervention for Prevention of Major Depression in Adults With Subthreshold Depression: A Randomized Clinical Trial
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IMPORTANCE: Evidence-based treatments for major depressive disorder (MDD) are not very successful in improving functional and health outcomes. Attention has increasingly been focused on the prevention of MDD. OBJECTIVE: To evaluate the effectiveness of a web-based guided self-help intervention for the prevention of MDD. DESIGN, SETTING, AND PARTICIPANTS: Two-group randomized clinical trial conducted between March 1, 2013, and March 4, 2015. Participants were recruited in Germany from the general population via a large statutory health insurance company (ie, insurance funded by joint employer-employee contributions). Participants included 406 self-selected adults with subthreshold depression (Centre for Epidemiologic Studies Depression Scale score ≥16, no current MDD according to Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition, Text Revision] criteria). INTERVENTIONS: All participants had unrestricted access to usual care (visits to the primary care clinician) and were randomized to either a web-based guided self-help intervention (cognitive-behavioral and problem-solving therapy supported by an online trainer; n = 202) or a web-based psychoeducation program (n = 204). MAIN OUTCOMES AND MEASURES: The primary outcome was time to onset of MDD in the intervention group relative to the control group over a 12-month follow-up period as assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. RESULTS: Among 406 randomized patients (mean age, 45 years; 73.9% women), 335 (82%) completed the telephone follow-up at 12 months. Fifty-five participants (27%) in the intervention group experienced MDD compared with 84 participants (41%) in the control group. Cox regression analyses controlling for baseline depressive symptom severity revealed a hazard ratio of 0.59 (95% CI, 0.42-0.82; P = .002) at 12-month follow-up. The number needed to treat to avoid 1 new case of MDD was 5.9 (95% CI, 3.9-14.6). CONCLUSIONS AND RELEVANCE: Among patients with subthreshold depression, the use of a web-based guided self-help intervention compared with enhanced usual care reduced the incidence of MDD over 12 months. Further research is needed to understand whether the effects are generalizable to both first onset of depression and depression recurrence as well as efficacy without the use of an online trainer. TRIAL REGISTRATION: German Clinical Trial Registry Identifier: DRKS00004709.
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The German version of the TiC-P has been used in several studies.
“The German version of the TiC-P has been used in several studies (eg, see refs. 48 100 101).”
From Clinical and cost-effectiveness of a guided internet-based Acceptance and Commitment Therapy to improve chronic pain-related disability in green professions (PACT-A): Study protocol of a pragmatic randomised controlled trial (2020) · cites this paper as [101]
The Interventions section reports using the TiC-P to measure health care utilization, and Trial Design and Participants places the study in Germany. The paper does not specify that the questionnaire used was the German version. As one of several cited examples, it supports use in this study, but not that version-specific detail. (LLM, conf=0.83)
Experimental — accuracy not yet measuredE-mental health interventions have acquired a solid empirical basis for the prevention and treatment of various psychological conditions in adults, including depression, anxiety, and alcohol use.
“Mental health interventions provided on a computer or via the Internet, which we will henceforth denote as e-mental health interventions, have acquired a solid empirical basis for the prevention and treatment of various psychological conditions in adults, including depression (Buntrock et al., 2016; Karyotaki et al., 2017), anxiety (Grist et al., 2019), and alcohol use (Riper et al., 2018).”
From The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials (2020) · cites this paper as Buntrock et al., 2016
Buntrock et al. support the depression-prevention part of the citation: the Effectiveness of Intervention section reports fewer new cases of major depression with web-based guided self-help than with the control condition. The paper also notes that web-based interventions reduce depressive symptoms, but this trial studied adults with subthreshold depression and did not establish treatment efficacy for diagnosed depression. The sentence cites other papers for anxiety and alcohol use. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe intervention is based on GET.ON Mood Enhancer, a program that has been evaluated in multiple randomised controlled trials.
“The intervention is based on “GET.ON Mood Enhancer,” a program that has been evaluated in multiple randomised controlled trials (62–64).”
From Personalised depression forecasting using mobile sensor data and ecological momentary assessment (2022) · cites this paper as [62]
On-line screening and intervention programs have been shown to be feasible and effective for reducing symptoms and preventing onset of full mental disorders.
“On-line screening and intervention programs have been evaluated and shown to be feasible and effective for reducing symptoms (Andersson & Cuijpers, 2009; Spek et al., 2008) and prevent onset of full mental disorders (Buntrock et al., 2016).”
From Severe role impairment associated with mental disorders: Results of the WHO World Mental Health Surveys International College Student Project (2018) · cites this paper as Buntrock et al., 2016
True prevention in the form of reduced 12-month incidence rates was an outcome measure in only two studies.
“Symptom reduction was the primary outcome in all studies, with true prevention in the form of reduced 12-month incidence rates an outcome measure in only two studies [41, 52].”
From eHealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis (2017) · cites this paper as [41]
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Self-citation
- Authors
- Buntrock, C., Ebert, D. D., Lehr, D., Smit, F., Riper, H., Berking, M., & Cuijpers, P.
- Affiliations
- Leuphana University of Lüneburg (DE)
- Trimbos Institute (NL)
- Corresponding author
- Ebert, David Daniel
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-05-03
- Volume
- 315
- Issue
- 17
- Pages
- 1854
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2345502178
- Cited by
- 232
- References
- 42
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 10 · 2023: 15 · 2022: 17 · 2021: 21 · 2020: 33 · 2019: 25 · 2018: 27 · 2017: 39 · 2016: 9
- FWCI
- 51.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Pure Amsterdam UMC (acceptedVersion, other-oa)
- eScholarship@McGill (McGill) (submittedVersion)
- Multilingual Matters (Channel View Publications) (submittedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- European Commission
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- subthreshold depression, cognitive behavioral therapy, problem-solving therapy, online psychoeducation, online intervention, primary care, adults, number needed to treat, workplace mental health promotion, cost-effectiveness, quality of life
- MeSH terms
- Adult, Depression, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Primary Health Care, Problem Solving, Recurrence, Self Care, Cognitive Behavioral Therapy, Internet
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