Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders.
Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders.
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DOI：
10.2196/jmir.7.2.e16
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发表时间：
2005-06-21
影响因子：
7.4
通讯作者：
Gullion C
中科院分区：
文献类型：
--
作者：
Clarke G;Eubanks D;Reid E;Kelleher C;O'Connor E;DeBar LL;Lynch F;Nunley S;Gullion C
通过互联网成功地提供了抑郁症自助指导方案（与相关的治疗师联系）。然而，以前的纯自助互联网抑郁症（没有治疗师联系）的试验，包括我们早期进行的试验，都没有产生积极的结果。我们假设，增加参与者使用干预措施的方法，如明信片或电话提醒，可能会对抑郁症产生显着影响。本文介绍了一个纯粹的自助互联网网站，ODIN（克服抑郁症的互联网）的第二次随机试验，为成年人与自我报告的抑郁症。我们假设，经常被提醒的参与者接受互联网程序将报告更大的减少抑郁症状和更大的改善心理和身体健康功能比对照组与常规治疗和没有访问ODIN。这是一项三臂随机对照试验，其中一个常规治疗对照组和两个ODIN干预组通过明信片或简短的电话接受提醒。这是一个非营利性的健康维护组织（HMO）。我们通过美国邮政将招募手册邮寄给两组：在过去30天内接受抑郁症药物或心理治疗的成年人（n = 6030），以及年龄和性别匹配的成年人（n = 6021），他们没有接受此类服务。在入组和5周、10周和16周随访时，通过电子邮件（和电话，如果没有回复）提醒参与者完成流行病学研究中心抑郁量表（CES-D）和简明量表12（SF-12）的在线版本。我们还记录了参与者HMO在研究入组后12个月内的医疗保健服务利用情况。在招募的12051名受试者中，255人访问了互联网招募网站，完成了在线知情同意书，并被随机分配至三组之一：（1）不访问ODIN网站的常规对照组（n = 100），（2）ODIN程序组（n = 75），（3）ODIN方案加电话提醒组（n = 80）。在所有组中，5周时的随访完成率为64%（n = 164），10周时为68%（n = 173），16周时为66%（n = 169）。在意向治疗分析中，干预参与者报告与对照组相比抑郁症的减少更大（P = 0.03;效应量= 0.277标准差单位）。在基线时抑郁程度更严重的参与者中检测到更明显的影响（P = 0.02;效应量= 0.537标准差单位）。到研究结束时，20%以上的干预参与者在CES-D上从紊乱转为正常。我们发现两个干预组在结果测量或登录频率方面没有差异。我们也没有发现对SF-12或医疗保健服务的显著干预效果。与我们早期的试验相反，在该试验中，参与者没有被提醒使用ODIN，在该试验中，我们发现与对照组相比，ODIN干预具有积极作用。未来的研究应解决本试验的局限性，包括相对较低的入组率和随访完成率，以及有限数量的结局指标。然而，提供这种互联网程序的低增量成本使得向广泛接入互联网的大量人口提供这种类型的程序是可行的。
Guided self-help programs for depression (with associated therapist contact) have been successfully delivered over the Internet. However, previous trials of pure self-help Internet programs for depression (without therapist contact), including an earlier trial conducted by us, have failed to yield positive results. We hypothesized that methods to increase participant usage of the intervention, such as postcard or telephone reminders, might result in significant effects on depression. This paper presents a second randomized trial of a pure self-help Internet site, ODIN (Overcoming Depression on the InterNet), for adults with self-reported depression. We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN. This was a three-arm randomized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls. The setting was a nonprofit health maintenance organization (HMO). We mailed recruitment brochures by US post to two groups: adults (n = 6030) who received depression medication or psychotherapy in the previous 30 days, and an age- and gender-matched group of adults (n = 6021) who did not receive such services. At enrollment and at 5-, 10- and 16-weeks follow-up, participants were reminded by email (and telephone, if nonresponsive) to complete online versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Short Form 12 (SF-12). We also recorded participant HMO health care services utilization in the 12 months following study enrollment. Out of a recruitment pool of 12051 approached subjects, 255 persons accessed the Internet enrollment site, completed the online consent form, and were randomized to one of the three groups: (1) treatment as usual control group without access to the ODIN website (n = 100), (2) ODIN program group with postcard reminders (n = 75), and (3) ODIN program group with telephone reminders (n = 80). Across all groups, follow-up completion rates were 64% (n = 164) at 5 weeks, 68% (n = 173) at 10 weeks, and 66% (n = 169) at 16 weeks. In an intention-to-treat analysis, intervention participants reported greater reductions in depression compared to the control group (P = .03; effect size = 0.277 standard deviation units). A more pronounced effect was detected among participants who were more severely depressed at baseline (P = .02; effect size = 0.537 standard deviation units). By the end of the study, 20% more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons. We also found no significant intervention effects on the SF-12 or health care services. In contrast to our earlier trial, in which participants were not reminded to use ODIN, in this trial we found a positive effect of the ODIN intervention compared to the control group. Future studies should address limitations of this trial, including relatively low enrollment and follow-up completion rates, and a restricted number of outcome measures. However, the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large populations with widespread Internet access.
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