Effectiveness and cost effectiveness of guided online treatment for patients with major depressive disorder on a waiting list for psychotherapy: study protocol of a randomized controlled trial
Open accessAbstract
BACKGROUND: Depressive disorders are highly prevalent and result in negative consequences for both patients and society. It is therefore important that these disorders are treated adequately. However, due to increased demand for mental healthcare and subsequent increased costs, it would be desirable to reduce costs associated with major depressive disorder while maintaining or improving the quality of care within the healthcare system. Introducing evidence-based online self-help interventions in mental healthcare might be the way to maintain clinical effects while minimizing costs by reducing the number of face-to-face sessions. This study aims to evaluate the clinical and economical effects of a guided online self-help intervention when offered to patients with major depressive disorder on a waiting list for psychotherapy in specialized mental health centers (MHCs). METHODS: Patients at mental health centers identified with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of major depression who are awaiting face-to-face treatment are studied in a randomized controlled trial. During this waiting list period, patients are randomized and either (1) receive an internet-based guided self-help treatment or (2) receive a self-help book. The 5-week internet-based guided self-help intervention and the self-help booklet are based on problem solving treatment. After the intervention, patients are allowed to start regular face-to-face treatment at MHCs. Costs and effects are measured at baseline, after the intervention at 6 to 8 weeks, 6 months and 12 months. The primary outcome measure is symptoms of depression. Secondary outcome measures are diagnosis of depression, number of face-to-face sessions, absence of work and healthcare uptake in general. Additional outcome measures are anxiety, insomnia, quality of life and mastery. DISCUSSION: This study evaluates the effectiveness and cost effectiveness of internet-based guided self-help in patients at specialized mental health centers. The aim is to demonstrate whether the introduction of internet-based self-help interventions in regular mental healthcare for depressive disorders can maintain clinical effects and reduce costs. Strengths and limitations of this study are discussed. TRIAL REGISTRATION: Netherlands Trial Register NTR2824.
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Only a limited number of trials have specifically evaluated Internet-based treatments in outpatient clinics and secondary care for common mental disorders.
“only a limited number of trials have specifically evaluated Internet-based treatments in outpatient clinics and secondary care for common mental disorders [30-33].”
From Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial. (2014) · cites this paper as [30]
The Discussion (Strengths and Limitations; page unavailable) says there are few relevant RCTs in specialized mental healthcare and describes this study as, to the authors’ knowledge, the first of its kind for major depressive disorder. That supports the scarcity claim for depression in specialized care, but the paper does not establish it across common mental disorders or outpatient clinics generally. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCombined cognitive behavioural face-to-face and online treatment for depression can achieve promising clinical results.
“The results suggest that this combination treatment can achieve promising clinical results (Hickie et al., 2010, Høifødt et al., 2013, Kenter et al., 2013, Robertson et al., 2006).”
From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Kenter et al., 2013
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- Authors
- Kenter, R. M., van Straten, A., Hobbel, S., Smit, F., Bosmans, J., Beekman, A., & Cuijpers, P.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Amsterdam Public Health (NL)
- Trimbos Institute (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Kenter, Robin Maria
- Venue
- Trials
- Published
- 2013
- Volume
- 14
- Issue
- 1
- Pages
- 412
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC4220817
- OpenAlex
- W2121192509
- Cited by
- 13
- References
- 39
- Citations by year
- 2024: 1 · 2023: 1 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 3
- FWCI
- 4.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Trials (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ZonMw
- 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
- major depressive disorder, online self-help intervention, cost-effectiveness, problem-solving therapy, mental health centers, self-help books, depressive symptoms, health care costs, absenteeism, quality of life
- MeSH terms
- Clinical Protocols, Cost-Benefit Analysis, Major Depressive Disorder, Humans, Psychotherapy, Quality of Life, Therapy, Computer-Assisted, Waiting Lists, Patient Satisfaction, Outcome Assessment, Health Care, Sample Size, Internet
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