How Effective is a Web-Based Mental Health Intervention (Deprexis) in
the Treatment of Moderate and Major Depressive Disorders when started during
Routine Psychiatric Inpatient Treatment as an Adjunct Therapy? A Pragmatic
Parallel-Group Randomized Controlled Trial
Authors: Richter Lisa Emily , Machleit-Ebner Annika , Scherbaum Norbert , Bonnet Udo 
Published: July 2022

Background Internet-based self-help-programs like deprexis have been
increasingly shown to reduce depressive symptoms if added to distinct, primarily
outpatient-treatment-settings. There is limited information about the
effectiveness of deprexis if started at routine psychiatric hospital inpatient
treatment of moderate-to-severe major depressive disorder (MDD).

Subjects and methods To examine, sixty-nine adult MDD-inpatients were
randomly assigned to a 12-week-period of treatment-as-usual (TAU, N=33)
or TAU plus guided deprexis (TAU-PLUS, N=36). The study was planned as a
pragmatic approach considering psychiatric routine conditions, particularly,
offering an instant and flexible discharge management when the patients felt
stabilized enough for primary/secondary care. Therefore, there was no
fixed time frame for the inpatient treatment duration. Post-discharge, patients
were followed by structured telephone interviews up to study-endpoint,
i. e., 12 weeks after deprexis-initiation. Primary
(Beck-Depression-Inventory-II, BDI-II) and secondary outcome-measures
(Hamilton-Depression-Scale, Clinical-Global-Impression-Severity,
WHO-Well-Being-Index, Helping-Alliance-Questionnaire) were carried out at study
entry and every 2 weeks. Furthermore, the working alliance with deprexis as well
as the inpatient treatment duration, the daily activity and the utilization of
post-hospital care after discharge were determined.

Results At week 12, modified ITT-analyses showed significant between-group
differences of BDI-II scores in favor of the TAU-PLUS-patients (p=.03)
corresponding to a medium effect size (d=−.73, 95% CI
−1.4 to .06). TAU-PLUS-patients showed greater daily activity
(p=.04, d=.70, 95% CI −.03 to 1.38) and had been
discharged significantly earlier from inpatient treatment (p=.003).
Post-discharge, the TAU-PLUS-group reported a lower rate of post-hospital care
(p=.01) and re-admissions (p=.04). Secondary outcome-measures
including the alliance with the therapists were not significantly different
between the groups at study-endpoint. The patients´ working-alliance
with deprexis significantly predicted MDD-improvement and wellbeing. Both groups
(TAU and TAU plus deprexis) were comparable with regard to the prescribed
antidepressant medication. Unfortunately, detailed data on the amount and actual
duration of the psychotherapeutic and special therapeutic individual and group
settings of the TAU were not collected

Conclusion TAU plus deprexis was superior to TAU in improving subjective
depression-severity (BDI-II) and daily activity in patients having sought
psychiatric inpatient MDD-treatment before. This beneficial effect appeared 12
weeks after inpatient deprexis-initiation, i. e. when the vast majority
of patients were back in primary/secondary care. Adjunctive deprexis was
associated with earlier discharges and a significant advantage for post-hospital
stabilization. In this regard, it could be promising to include deprexis into
inpatient treatment conditions, thereby also preparing its continuing outpatient
use. We found no evidence that deprexis interfered negatively with the alliance
between the patients and their therapists.