title: Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial.
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. Complete 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.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building O59, 20246 Hamburg, Germany. bj.meyer@uke.uni-hamburg.de
authors.forename: Björn
authors.initials: B
authors.lastname: Meyer
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
authors.forename: Franz
authors.initials: F
authors.lastname: Caspar
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Beevers
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.forename: Mario
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000328:Adult; D001519:Behavior; D001521:Behavior Therapy; D003071:Cognition; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D004644:Emotions; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008019:Life Style; D008297:Male; D009862:Online Systems; D010353:Patient Education as Topic; D010555:Personality Inventory; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D012917:Social Adjustment; D012919:Social Behavior; D012944:Social Support