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Journal of Diabetes Research
Article . 2019 . Peer-reviewed
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Journal of Diabetes Research
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Article . 2019
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Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial

Authors: Sandra Schlicker; Kiona K. Weisel; Claudia Buntrock; Matthias Berking; Stephanie Nobis; Dirk Lehr; Harald Baumeister; +3 Authors

Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial

Abstract

Introduction. Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Methods. Randomized controlled trial- (RCT-) based data (N=253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES−D>40; N=40). Results. Major depressive disorder diagnosis at the baseline (pprf6=0.01), higher levels of depression (Beck Depression Inventory II; pprpo=0.00; pprf6=0.00), and lower HbA1c (pprpo=0.04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (dprpo=2.17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (dprpo=0.92; 95% CI: 0.001-1.83), with a between-group effect size of dprpo=1.05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ2 2N=40=4.44; p<0.02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (dpr6f=0.71; 95% CI: 0.19-1.61) but not treatment response. Conclusion. Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.

Keywords

Adult, Male, Health Behavior, Comorbidity, Philosophische Fakultät und Fachbereich Theologie, Psychological Distress, Diseases of the endocrine glands. Clinical endocrinology, SDG 3 - Good Health and Well-being, Patient Education as Topic, /dk/atira/pure/subjectarea/asjc/1300/1310; name=Endocrinology, Humans, /dk/atira/pure/core/keywords/600089002; name=Psychology, /dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being; name=SDG 3 - Good Health and Well-being, Language, Depressive Disorder, Major, Internet, Cognitive Behavioral Therapy, Middle Aged, RC648-665, Psychotherapy, Self Care, Affect, Self-Help Groups, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Data Interpretation, Statistical, /dk/atira/pure/subjectarea/asjc/2700/2712; name=Endocrinology, Diabetes and Metabolism, Female, Research Article, ddc: ddc:150

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
18
Top 10%
Average
Top 10%
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gold