Internet-delivered intervention strategy for recurrent depression: Towards individualized disease management

抑郁症是一种高度流行的致残性疾病，与受影响的个人及其家庭的生活质量下降和社会的巨大经济负担有关。大多数MD遵循复发的病程，复发的风险很高。本研究将探讨两种基于互联网技术(IT)的个体化干预对复发MD患者的疗效，并与常规治疗进行比较。在实验条件下，个人将在住院治疗后参加为期12个月的基于信息技术的干预。这些干预措施包括支持性监测、同行支持的在线论坛，以及有或没有个人临床支持的危机管理。参与者将每两周提供一次关于他们症状的数据，并将收到针对他们的症状量身定做的支持性反馈。如果监测发出危机开始的信号，就会启动个性化的危机管理。样本将由患有MD的成年人组成，他们至少经历过三次发作，并且可以上网。主要结果被定义为指数治疗后24个月内的“健康周”数。次要结果将是症状过程、复发次数、服务利用率和生活质量。潜在的主持人也将被审查。自动化但个性化干预的低货币和非货币支出为为患有慢性疾病(如复发的MD)的个人提供有用、可接受和负担得起的疾病管理开辟了新的途径。

Major depression (MD) is a highly prevalent, disabling disorder that is associated with the loss of quality of life in affected individuals and their families, and large economic burdens for the society. Most MDs follow a recurrent course and the risk of relapse is high. This study will investigate the efficacy of two individualized interventions based on internet technology (IT) for patients with recurrent MD compared to treatment as usual. In the experimental conditions, individuals will participate in an IT-based intervention for 12 months after inpatient treatment. The interventions consist of supportive monitoring, an online forum for peer support, and crisis management either with or without personal clinical support. Participants will provide data on their symptoms bi-weekly and will receive supportive feedback tailored to their symptoms. If the monitoring signals a beginning of a crisis, an individualized crisis management will be initiated. The sample will be composed of adults with MD who have experienced at least three episodes, and who have internet access. The primary outcome is defined as the number of ”well weeks” over 24 months after index treatment. The secondary outcomes will be course of symptoms, number of relapses, service utilization, and quality of life. Potential moderators also will be examined. Low monetary and nonmonetary expenditures of automated, yet individualized interventions open new avenues for providing a helpful, acceptable and affordable disease management for individuals who are suffering from a chronic condition such as recurrent MD.