TY  - JOUR
AU  - van Bastelaar, Kim MP
AU  - Pouwer, François
AU  - Cuijpers, Pim
AU  - Riper, Heleen
AU  - Twisk, Jos WR
AU  - Snoek, Frank J
PY  - 2012
DA  - 2012/01/05
TI  - Is a Severe Clinical Profile an Effect Modifier in a Web-Based Depression Treatment for Adults With Type 1 or Type 2 Diabetes? Secondary Analyses From a Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e2
VL  - 14
IS  - 1
KW  - Diabetes mellitus, type 1
KW  - diabetes mellitus, type 2
KW  - depression
KW  - behavior therapy
KW  - cognitive therapy
KW  - depressive disorder
KW  - adults
KW  - psychology
AB  - Background: Depression and diabetes are two highly prevalent and co-occurring health problems. Web-based, diabetes-specific cognitive behavioral therapy (CBT) depression treatment is effective in diabetes patients, and has the potential to be cost effective and to have large reach. A remaining question is whether the effectiveness differs between patients with seriously impaired mental health and patients with less severe mental health problems. Objective: To test whether the effectiveness of an eight-lesson Web-based, diabetes-specific CBT for depression, with minimal therapist support, differs in patients with or without diagnosed major depressive disorder (MDD), diagnosed anxiety disorder, or elevated diabetes-specific emotional distress (DM-distress). Methods: We used data of 255 patients with diabetes with elevated depression scores, who were recruited via an open access website for participation in a randomized controlled trial, conducted in 2008–2009, comparing a diabetes-specific, Web-based, therapist-supported CBT with a 12-week waiting-list control group. We performed secondary analyses on these data to study whether MDD or anxiety disorder (measured using a telephone-administered diagnostic interview) and elevated DM-distress (online self-reported) are effect modifiers in the treatment of depressive symptoms (online self-reported) with Web-based diabetes-specific CBT. Results: MDD, anxiety disorder, and elevated DM-distress were not significant effect modifiers in the treatment of self-assessed depressive symptoms with Web-based diabetes-specific CBT. Conclusions: This Web-based diabetes-specific CBT depression treatment is suitable for use in patients with severe mental health problems and those with a less severe clinical profile. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 24874457; http://www.controlled-trials.com/ISRCTN24874457 (Archived by WebCite at http://www.webcitation.org/63hwdviYr) 
SN  - 1438-8871
UR  - http://www.jmir.org/2012/1/e2/
UR  - https://doi.org/10.2196/jmir.1657
UR  - http://www.ncbi.nlm.nih.gov/pubmed/22262728
DO  - 10.2196/jmir.1657
ID  - info:doi/10.2196/jmir.1657
ER  -