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

重性抑郁症（MD）是一种高度流行的致残性疾病，其与受影响的个体及其家庭的生活质量的丧失以及社会的巨大经济负担相关。大多数MD遵循复发过程，复发的风险很高。本研究将探讨两种基于互联网技术（IT）的个性化干预措施对复发性MD患者的疗效，并与常规治疗进行比较。在实验条件下，患者将在住院治疗后参加为期12个月的基于IT的干预。干预措施包括支持性监测，在线论坛的同行支持，危机管理，无论有或没有个人的临床支持。参与者将每两周提供一次症状数据，并将收到针对其症状的支持性反馈。如果监测表明危机开始，将启动个性化的危机管理。样本将由至少经历过三次发作并且可以上网的MD成年人组成。主要结局定义为指标治疗后24个月内的“良好周数”。次要结果将是症状过程、复发次数、服务利用和生活质量。还将审查潜在的主持人。低货币和非货币支出的自动化，但个性化的干预措施开辟了新的途径，提供一个有用的，可接受的和负担得起的疾病管理的个人谁是患有慢性疾病，如复发性MD。

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.