@Article{info:doi/10.2196/jmir.1151,
author="Meyer, Bj{\"o}rn
and Berger, Thomas
and Caspar, Franz
and Beevers, Christopher G
and Andersson, Gerhard
and Weiss, Mario",
title="Effectiveness of a Novel Integrative Online Treatment for Depression (Deprexis): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2009",
month="May",
day="11",
volume="11",
number="2",
pages="e15",
abstract="Background:  Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training. Objective:  To evaluate the effectiveness of the Web-based intervention in a randomized controlled trial. Methods:  There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Completer analyses and intention-to-treat analyses were performed. Results:  Of 396 participants, 216 (55{\%}) completed the post-measurement 9 weeks later. Available case analyses revealed a significant reduction in depression severity (BDI), Cohen's d = .64 (CI 95{\%} = 0.33 - 0.94), and significant improvement in social functioning (WSA), Cohen's d = .64, 95{\%} (CI 95{\%} = 0.33 - 0.95). These improvements were maintained at 6-month follow-up. Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements (BDI: Cohen's d = .30, CI 95{\%} = 0.05 - 0.55; WSA: Cohen's d = .36, CI 95{\%} = 0.10 - 0.61). Moreover, a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms (BDI: odds ratio [OR] = 6.8, CI 95{\%} = 2.90 - 18.19) and recovered more often (OR = 17.3, 95{\%} CI 2.3 - 130). More than 80{\%} of the users felt subjectively that the program had been helpful. Conclusions:  This integrative, Web-based intervention was effective in reducing symptoms of depression and in improving social functioning. Findings suggest that the program could serve as an adjunctive or stand-alone treatment tool for patients suffering from symptoms of depression. Trial Registration:  International Standard Randomized Controlled Trial Number (ISRCTN): 64953693; http://www.controlled-trials.com/ISRCTN64953693/64953693 (Archived by WebCite at http://www.webcitation.org/5ggzvTJPD)                     ",
issn="1438-8871",
doi="10.2196/jmir.1151",
url="http://www.jmir.org/2009/2/e15/",
url="https://doi.org/10.2196/jmir.1151",
url="http://www.ncbi.nlm.nih.gov/pubmed/19632969"
}