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

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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.