The association between adherence and outcome in an Internet intervention for depression
The association between adherence and outcome in an Internet intervention for depression
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DOI：
10.1016/j.jad.2017.12.028
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发表时间：
2018-03-15
影响因子：
6.6
通讯作者：
Klein, Jan Philipp
中科院分区：
文献类型：
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作者：
Fuhr, Kristina;Schroeder, Johanna;Klein, Jan Philipp
背景：据报道，对互联网干预措施的依从性相当低，这可能对这些干预措施的有效性产生不利影响。在一项大型网络干预抑郁症的随机对照试验中，我们调查了患者特征是否与依从性相关，以及依从性是否与治疗结果相关。方法：将患者随机分为常规护理组（CAU）和CAU +网络干预组。共有509名有轻度至中度抑郁症状的参与者被纳入干预组，并参与了本研究。我们评估干预前后（12周）的抑郁症状。在随机化之前，对患者特征、精神障碍自评筛查、对在线干预的态度和生活质量进行了评估。结果：这项研究的依从性很好，平均使用时间为7小时，干预时间为8次。患者的一些特征（年龄、性别、抑郁症状和对项目有效性的信心）在不同的模型中预测了更高的治疗次数（解释了总方差在15%到25%之间）。年龄越大（β = 0.16）和抑郁症状越严重（β = 0.15），使用时间越长。较高的依从性预示着在12周内抑郁症状会有更大的减轻（疗程数：β = 0.13，使用时间：β = 0.14），然而，这种预测主要可以通过接受指导来解释（β = 0.27和0.26）。局限性：在基线时接受指导和症状严重程度是混淆的，因为只有在基线时症状严重程度中等的参与者才接受电子邮件支持。因此，从我们观察到的基线症状严重程度和使用强度之间的关系中不能得出确切的结论。结论：我们的结论是，年龄与依从性相关，并且依从性与结果呈正相关。然而，我们发现的影响很小，这表明依从性也可能受到其他变量的影响。
Background: Adherence to Internet interventions is often reported to be rather low and this might adversely impact the effectiveness of these interventions. We investigated if patient characteristics are associated with adherence, and if adherence is associated with treatment outcome in a large RCT of an Internet intervention for depression, the EVIDENT trial.Methods: Patients were randomized to either care as usual (CAU) or CAU plus the Internet intervention Deprexis. A total of 509 participants with mild to moderate depressive symptoms were included in the intervention group and of interest for the present study. We assessed depression symptoms pre and post intervention (12 weeks). Patient characteristics, a self-rating screening for mental disorders, attitudes towards online interventions, and quality of life were assessed before randomization.Results: Adherence in this study was good with on average seven hours of usage time and eight number of sessions spent with the intervention. Some of the patient characteristics (age, sex, depressive symptoms, and confidence in the effectiveness of the program) predicted higher number of sessions in different models (explaining in total between 15 and 25% of variance). Older age (beta = .16) and higher depressive symptoms (beta = .15) were associated with higher usage duration. Higher adherence to the program predicted a greater symptom reduction in depressive symptoms over 12 weeks (number of sessions: beta = .13, usage duration: beta = .14), however, this prediction could mostly be explained by receiving guidance (beta = .27 and .26).Limitations: Receiving guidance and symptom severity at baseline were confounded since only participants with a moderate symptom severity at baseline received e-mail support. Therefore no firm conclusions can be drawn from the association we observed between baseline symptom severity and usage intensity.Conclusions: We conclude that older age was associated with adherence and adherence was positively associated with outcome. The effects we have found were small however suggesting that adherence might also be influenced by further variables.