JMIR mental health · 2025
Treatment Without Cost? Effects and Side Effects of an Internet-Based Intervention for Depression: Randomized Controlled Trial.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Baumeister Anna, Schuurmans Lea, Bruhns Alina, Moritz Steffen
Аннотация
BACKGROUND: Internet-based interventions for depression are increasingly integrated into health care due to their effectiveness, availability, and cost-effectiveness. However, negative effects have largely been ignored.
OBJECTIVE: This study aimed to evaluate both positive and negative effects of an unguided intervention.
METHODS: In total, 303 participants were analyzed using mixed models for repeated measures to assess changes in depressive symptoms via Beck Depression Inventory-II (primary outcome) after 12 weeks compared to waitlist controls with care as usual. Secondary endpoints included depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), self-esteem, and quality of life. Negative effects were evaluated using the positive and negative effects of psychotherapy scale for internet-based interventions (PANEPS-I). Moderation analyses were conducted to explore influential effects on treatment outcomes.
RESULTS: The intervention group showed greater reduction in depressive symptoms compared to controls, with small to medium effect sizes (g=0.30-0.42) with averaged 14 logins. Although improvements in self-esteem and quality of life were not observed in intention-to-treat analyses, the completer sample indicated higher self-esteem in the intervention group. Negative effects were reported by 22% (22/100) to 68% (66/97), with the highest rates for program-related effects (eg, not addressing personal problems). No moderation effects were identified.
CONCLUSIONS: The intervention effectively reduces depressive symptoms. Although negative effects were present, they did not impact treatment outcome, tentatively suggesting that overall benefits may outweigh the negative effects for users.
OBJECTIVE: This study aimed to evaluate both positive and negative effects of an unguided intervention.
METHODS: In total, 303 participants were analyzed using mixed models for repeated measures to assess changes in depressive symptoms via Beck Depression Inventory-II (primary outcome) after 12 weeks compared to waitlist controls with care as usual. Secondary endpoints included depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), self-esteem, and quality of life. Negative effects were evaluated using the positive and negative effects of psychotherapy scale for internet-based interventions (PANEPS-I). Moderation analyses were conducted to explore influential effects on treatment outcomes.
RESULTS: The intervention group showed greater reduction in depressive symptoms compared to controls, with small to medium effect sizes (g=0.30-0.42) with averaged 14 logins. Although improvements in self-esteem and quality of life were not observed in intention-to-treat analyses, the completer sample indicated higher self-esteem in the intervention group. Negative effects were reported by 22% (22/100) to 68% (66/97), with the highest rates for program-related effects (eg, not addressing personal problems). No moderation effects were identified.
CONCLUSIONS: The intervention effectively reduces depressive symptoms. Although negative effects were present, they did not impact treatment outcome, tentatively suggesting that overall benefits may outweigh the negative effects for users.