Effects of an Internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial
Open accessAbstract
Background Studies have shown that certain Internet interventions can help alleviate depression. However, many such interventions contain personal support elements, making it difficult to ascertain whether the program or the support drives the effects. Studies are needed to investigate whether Internet interventions contribute to symptom reduction even when they are delivered without personal support, and even among severely depressed individuals who often receive other forms of treatment. Objective This randomized controlled trial aimed to examine the effect of an Internet intervention that was deployed without personal support (“Deprexis”) among adults with initially severe depression symptoms. Methods Adults recruited from a range of sources who had exceeded the threshold for severe depression (PHQ-9 ≥ 15) in a pre-screening assessment and met inclusion criteria were randomized ( N = 163) to the intervention (3 months program access; n = 78) or care-as-usual/waitlist control ( n = 85). A diagnostic screening interview was administered by telephone at baseline to all participants. Online assessments were administered at baseline, 3 months (post-treatment), and 6 months (follow-up). The main outcome was the Patient Health Questionnaire (PHQ-9) between baseline and post-treatment. Results Eighty-two percent of randomized participants were reached for the post-treatment assessment. Results for the intention-to-treat (ITT) sample showed significant intervention effects on depression reduction between baseline and post-treatment (linear mixed model [MM], F 1,155.6 = 9.00, p < .01, for the time by condition interaction), with a medium between-group effect size, Cohen's d = 0.57 (95% CI: 0.22–0.92). Group differences in depression severity at follow-up were marginally significant in the ITT sample, t (119) = 1.83, p = 0.07, and smaller than at post-treatment (PHQ-9, d = 0.33, 95% CI: − 0.03–0.69). The number needed to treat (NNT) at post-treatment was 5, with 38% of participants in the intervention group achieving response (at least 50% PHQ-9 symptom change, plus post-treatment score < 10), compared to 17% in the control group, p < 0.01. Effects on secondary outcomes, including anxiety, health-related quality of life, and somatic symptoms, were not significant, with the exception of significant effects on anxiety reduction in PP analyses. Early ratings of program helpfulness/alliance (after 3 weeks) predicted pre–post depression reduction, controlling for baseline severity and early symptom change. Conclusions These results replicate and extend previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months and, perhaps to a lesser degree, up until 6 months among adults with initially severe depression.
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Self-help interventions have a small but significant effect size compared to a control condition.
“the results so far indicate a small but significant effect size of these self-help interventions compared to a control condition [43–47].”
From An Internet-based treatment for flying phobia (NO-FEAR Airlines): Study protocol for a randomized controlled trial (2016) · cites this paper as [47]
The Results (§3.3) report a significant benefit over the control group at post-treatment, but its between-group effect size was medium (d = 0.57), not small. The small effect at follow-up (d = 0.33) was only marginally significant in the intention-to-treat sample (§3.5). The paper therefore supports a benefit for this intervention, but not the unqualified claim of a small, significant effect for self-help interventions generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredContradictory to findings in internet-based therapy studies, the alliance was unrelated to improvements in participants' mental well-being.
“However, contradictory to findings in internet-based therapy studies [130,131], the alliance was unrelated to improvements in participants’ mental well-being.”
The findings are in line with previous studies showing overall importance of alliance for internet interventions and specific relevance of alliance with an online program.
“These findings are in line with the results of several studies showing the overall importance of an alliance for internet interventions [1] and the specific relevance of the alliance with an online program for treatment outcomes [18,25].”
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Self-citationDefining and Predicting Patterns of Early Response in a Web-Based Intervention for Depression
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Self-citationWorking alliance with an avatar: How far can we go with internet interventions?
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Reciprocal Associations between Burnout and Depression: An 8‐Year Longitudinal Study
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“However, contradictory to findings in internet-based therapy studies [130,131], the alliance was unrelated to improvements in participants’ mental well-being.”
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How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study
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Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review
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Internet- und mobilebasierte Psychotherapie der Depression
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Self-citationEffects of Emotional Intelligence Training on Symptom Severity in Patients With Depressive Disorders
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Onlinetherapie bei depressiven Störungen
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Self-citationYuva: An e-health model for dealing with psychological issues of adolescents
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Self-citation
- Authors
- Meyer, B., Bierbrodt, J., Schröder, J., Berger, T., Beevers, C. G., Weiss, M., Jacob, G., Späth, C., Andersson, G., Lutz, W., Hautzinger, M., Löwe, B., Rose, M., Hohagen, F., Caspar, F., Greiner, W., Moritz, S., & Klein, J. P.
- Affiliations
- City, University of London (GB)
- University Medical Center Hamburg-Eppendorf (DE)
- University of Bern (CH)
- The University of Texas at Austin (US)
- GAIA (Germany) (DE)
- University of Freiburg (DE)
- University of Lübeck (DE)
- Linköping University (SE)
- Universität Trier (DE)
- University of Tübingen (DE)
- Schön Klinik Hamburg Eilbek (DE)
- University of Massachusetts Chan Medical School (US)
- Bielefeld University (DE)
- Corresponding author
- Meyer, Björn
- ORCID
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 2
- Issue
- 1
- Pages
- 48-59
- ISSN
- 2214-7829 (ISSN-L)
- OpenAlex
- W2046949542
- Cited by
- 188
- References
- 75
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 18 · 2023: 17 · 2022: 16 · 2021: 18 · 2020: 19 · 2019: 25 · 2018: 17 · 2017: 24 · 2016: 13 · 2015: 3
- FWCI
- 20.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by-nc-nd)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open Access CRIS of the University of Bern
- Funders
- Gaia AG
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- severe depression, online intervention, Deprexis, self-help, internet-based cognitive behavioral therapy, PHQ-9, depression symptom reduction, anxiety, health-related quality of life, somatic symptoms, waitlist control, number needed to treat, digital mental health interventions, adults with depression
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