Adherence to the iFightDepression Online Self-help Tool for Mild and Moderate Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Background Computerized cognitive behavioural therapy (cCBT) is proven to be an effective
      self-help tool for preventing depression and suicide. Patient adherence is one of the
      components that the effectiveness of cCBT self-help tools are dependent on and that needs to
      be researched for understanding and maximizing the effectiveness of computer-based
      interventions for depression and suicide.

      Aims The aims of this study were to compare the adherence of iFightDepression (iFD) online
      tool user patients with and without an extra weekly phone call consultation and to test
      predictors of adherence.
    

Detailed description: 
      Depressive disorders are recognized as one of the most widespread lifetime disorders and
      unipolar depression is identified as a leading cause of disease burden . These findings
      legitimate the importance of reducing depressive symptoms by implementing cost-effective
      interventions. Despite the fact that cognitive behaviour therapy (CBT) is proved to be an
      efficient treatment for depression, mental health care resources are scarce and cannot fulfil
      the huge amount of need for face-to-face psychotherapeutic treatments. The aim of
      increasingly deploying computerized cognitive behavioural therapy (cCBT) is to improve access
      to psychological treatments, reduce waiting lists, speed up clinical recovery and to bridge
      the paucity of specialists in small towns. Moreover, guided web-based self-help interventions
      are proved to be cost-effective and time-saving for mental health care systems as well.
      Numerous studies have proved the cCBT to be effective in case of depression, however drop-out
      rates of online self-help interventions are usually high - between 5 and 38.7%. Systematic
      reviews showed that in web-based self-help treatments extra support obtains higher adherence
      than no guidance. Treatment-adherence, defined as the amount of a therapeutic intervention
      that an individual engages with or completes, has clear clinical implications: poor adherence
      limits the exposure to the full program and increases the required 'dosage' of treatment.

      In the comparison of drop-out rates of different psychological treatments, no difference has
      been found between face-to-face and web-based interventions. Previous research has found that
      the drop-out risk from cCBT is significantly correlated with gender, educational level and
      age. Increased drop-out risk included male gender, younger age and lower educational level.
      This finding has been proved in another research as well, where females have been found to
      provide more effort to cope with depression compared to males.

      With regard to adherence, a low educational level might negatively influence the adherence to
      cCBT as understanding the content of intervention can be troublesome. Results from previous
      studies suggested that younger individuals had higher adherence to web-based treatment,
      whilst some other studies showed that younger age was related to low treatment adherence.
      Several findings also suggested that additional forms of guidance or support via phone or
      email increase the level of adherence. In order to offer web-based treatment to patients with
      the most benefits, it would be useful to identify the predictors of treatment adherence and
      causes of the relatively high dropout rate.

      Insomnia is one of the main symptoms of depression. Studies show insomnia to be one of the
      risk factors such for development of depression as for reducing response to depression
      treatment and increasing relapse of depression. Therefore, to quest a correlation between
      adherence in an online self-help program for depression and sleep disturbances would be
      subservient.

      Our goal in this study was to identify predictors of adherence to a computerized CBT program
      and to investigate whether sociodemographic variables, hopelessness and sleep disturbances
      are connected to adherence. Another objective was to compare adherence in web-based self-help
      intervention with and without weekly follow-up phone-calls as extra support. Our hypothesis
      was that phone-support would increase adherence level of cCBT.
    

Intervention name(s): iFightDepression online self-help tool; Treatment as Usual; phone call
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Computerized cognitive behavior therapy; TAU; phone call
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: depression; adherence; online self-help; cognitive behavior therapy