Internet-delivered intervention strategy for recurrent depression: Towards individualized disease management
Final Report Abstract
The trial underlines the urgent need for innovations that can help to improve care for these severely impaired patients with recurrent depression. According to the observed proportions of well weeks, people with recurrent depression receiving TAU can expect only 40.5 well weeks within two years, while those additionally receiving SUMMIT can expect 46.8 well weeks. Although the trial data do not promise a revolution, a gain of six well weeks (i.e., with not more than mild symptoms, PSR ≤ 2) through SUMMIT compared to TAU support hope for a substantial improvement. The explorations of the time to relapse after discharge from index treatment suggest a differential impact of the interventions compared to TAU. While participants with at worst mild depressive symptoms seem to benefit, those leaving the hospital with marked residual depressive symptoms did not. Relapses occurred quickly after discharge from the hospital in all three therapy arms. This might be due to the small step from a PSR of 3 or 4 to a score of 5 or 6, and the internet delivered interventions need time to work. This suggests to offer SUMMIT primarily to people with at worst mild depressive symptoms and/or add a more intensive relapse prevention module immediately after discharge from hospital. This promising finding holds although an additional gain of SUMMIT-PERSON compared to SUMMIT was not observed. The extra costs for the personal support through a clinical expert did not pay off. SUMMIT is a fully automated intervention, and thus, causes only low costs after implementation (besides the – fix – costs for the development of the software and hardware). The utilization data demonstrate that both internet-delivered interventions were well accepted by the study participants. Therefore, the future plans go into the following direction: Use of SUMMIT web-platform at the sites after study termination under conditions of clinical routine (if an agreement with health insurance companies will be achieved), preferable together with a more intensive relapse prevention module for those many who leave the hospital with substantial residual symptoms. - Adaptations for other patient groups suffering from other chronic conditions, e.g., bipolar depression, anxiety disorders, eating disorders, personality disorders, schizophrenia, Crohn’s disease etc. - Translation and effectiveness research.
Publications
- (2011). Supportives Monitoring in der Psychotherapie. Psychotherapeut, 56, 485-491
Wolf, M.
(See online at https://doi.org/10.1007/s00278-011-0870-z) - (2013). Supportive monitoring and disease management through the internet: An internet-delivered intervention strategy for recurrent depression. Contemporary Clinical Trials, 36, 327-337
Kordy, H., Backenstrass, M., Hüsing, J., Wolf, M., Aulich, K., Bürgy, M., Puschner, B., Rummel- Kluge, C. & Vedder, H.
(See online at https://doi.org/10.1016/j.cct.2013.08.005)
