Positive affect skills for depression: Optimizing internet and mobile delivery

描述(申请人提供)：抑郁症是一个主要的公共卫生问题。即使是抑郁症状的轻微增加也会导致日常功能的严重缺陷。只有50%的美国抑郁症患者得到了适当的治疗，而接受治疗的人中有三分之一没有受益。现在有证据表明，基于互联网的抑郁症干预可以低成本有效地接触到大量的人，但它们通常存在高流失率和低依从性的问题。我们提出一种干预措施，通过调整我们现有的基于互联网的积极情感技能干预来减少抑郁症状，适用于抑郁症患者。我们将开发和测试提高依从性的创新功能，包括在现实生活中在移动设备上使用的练习；与学习促进者非常简短的联系；通过私人的、有节制的互联网论坛提供同行支持；以及为用户提供强化和反馈的可选目标和挑战。材料和交付方法将经历多个周期的用户测试和比较评估，随后将进行随机测试，比较几种不同版本的干预措施。我们的目标是1)最大限度地提高抑郁症状或临床抑郁症患者的干预内容的可接受性和相关性；(2)开发提高保留率和依从性的方法；以及(3)收集关于降低抑郁症状水平的计划有效性的近端中介的初步数据。这项拟议的研究将通过收集关于积极心理干预有效性的证据，优化具有广泛传播和传播潜力的抑郁症在线干预，以及最大限度地保持和坚持成功的心理干预的两个关键组成部分，来扩展文献并为临床实践提供信息。

DESCRIPTION (provided by applicant): Depression is a major public health problem. Even slight elevations in depressive symptoms are associated with significant deficits in daily functioning. Only 50% of Americans with depression receive adequate treatment, and one-third of those receiving treatment do not benefit. There is now evidence that internet-based depression interventions can effectively reach large numbers of people at low cost, but they commonly have problems with high attrition and low adherence. We propose an intervention to reduce depressive symptoms by adapting our existing internet- based positive affect skills intervention for individuals with depression. We will develop and test innovative features for increasing adherence including exercises for use on mobile devices in real-life situations; very brief contact with a study facilitator; peer support via a private, moderated internet forum; and optional goals and challenges that provide users with reinforcement and feedback. The materials and delivery method will undergo multiple cycles of user testing and comparative evaluation, followed by a randomized test comparing several different versions of the intervention. We aim to 1) Maximize acceptability and relevance of intervention content for people with elevated depressive symptoms or clinical depression; (2) Develop methods for boosting retention and adherence, and (3) collect preliminary data regarding proximal mediators of efficacy of the program for reducing levels of depressive symptoms. The proposed study will extend the literature and inform clinical practice by gathering evidence regarding efficacy of positive psychological interventions; optimizing an online intervention for depression that has the potential for widespread reach and dissemination; and maximizing retention and adherence, two key components of successful psychological interventions.