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Abstract
Objective: Internet-delivered cognitive behavioral therapy (ICBT) is recommended as an efficient treatment alternative for depression in primary care. However, only few previous studies have been conducted at primary care centers (PCCs). We evaluated long-term effects of ICBT treatment for depression compared to treatment as usual (TAU) in primary care settings.
Design: Randomized controlled trial.
Setting: Patients were enrolled at16 PCCs in south-west Sweden.
Participants: Patients attending PCCs and diagnosed with depression (n = 90).
Interventions: Patients were assessed by a primary care psychologist/psychotherapist and randomized to ICBT or TAU. The ICBT included an ICBT program consisting of seven modules and weekly therapist e-mail or telephone support during the 3-month treatment period.
Main outcome measures: Questionnaires on depressive symptoms (BDI-II), quality of life (EQ-5D) and psychological distress (GHQ-12) were administered at baseline, with follow-ups at 3, 6 and 12 months. Antidepressants and sedatives use, sick leave and PCC contacts were registered.
Results: Intra-individual change in depressive symptoms did not differ between the ICBT group and the TAU group during the treatment period or across the follow-up periods. At 3-month follow-up, significantly fewer patients in ICBT were on antidepressants. However, the difference leveled out at later follow-ups. There were no differences between the groups concerning psychological distress, sick leave or quality of life, except for a larger improvement in quality of life in the TAU group during the 0- to 6-month period.
Conclusions: ICBT with weekly minimal therapist support in primary care can be equally effective as TAU among depressed patients also over a 12-month period.
Clinical trial registration: The trial was registered in the Swedish Registry, researchweb.org, ID number 30511.
Acknowledgements
This work was supported by grants from REHSAM (Swedish Social Insurance Agency) and Region Västra Götaland. The authors wish to acknowledge associate professor Ronny Gunnarsson for contributing with valuable support during planning of the PRIM-NET study.
Disclosure statement
The authors declare no conflicts of interest.
Notes on contributors
Maria C. M. Eriksson participated in the design of the RCT, was member of the trial management group (TMG), assisted during the whole conduct of the RCT at the PHCC sites, monitored data, drafted and revised the paper.
Marie Kivi participated in the design of the RCT, was member of the trial management group (TMG), assisted during the whole conduct of the RCT at the PHCC sites, monitored data, drafted and revised the paper.
Dominique Hange was member of the TMG, contributed to the trial design, drafted and revised the paper.
Eva-Lisa Petersson was trial manager during the conduct of the RCT, was member of the TMG, drafted and revised the paper.
Nashmil Ariai was member of the TMG, contributed to the trial design, drafted and revised the paper.
Per Häggblad was member of the TMG, contributed to the trial design, drafted and revised the paper.
Hans Ågren was member of the TMG, contributed to the trial design, drafted and revised the paper.
Fredrik Spak was member of the TMG, contributed to the trial design, drafted and revised the paper.
Ulf Lindblad was member of the TMG, contributed to the trial design, drafted and revised the paper.
Boo Johansson was member of the TMG, contributed to the trial design, drafted and revised the paper.
Cecilia Björkelund was chief investigator and initiated the project, designed the RCT, chaired TMG, drafted and revised the paper and is guarantor. All authors had full access to all of the study data and take responsibility for the integrity and accuracy of the data.