title: Effectiveness and cost effectiveness of guided online treatment for patients with major depressive disorder on a waiting list for psychotherapy: study protocol of a randomized controlled trial.
abstract: BACKGROUND
  Depressive disorders are highly prevalent and result in negative consequences for both patients and society. It is therefore important that these disorders are treated adequately. However, due to increased demand for mental healthcare and subsequent increased costs, it would be desirable to reduce costs associated with major depressive disorder while maintaining or improving the quality of care within the healthcare system. Introducing evidence-based online self-help interventions in mental healthcare might be the way to maintain clinical effects while minimizing costs by reducing the number of face-to-face sessions. This study aims to evaluate the clinical and economical effects of a guided online self-help intervention when offered to patients with major depressive disorder on a waiting list for psychotherapy in specialized mental health centers (MHCs).
  
  
  METHODS
  Patients at mental health centers identified with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of major depression who are awaiting face-to-face treatment are studied in a randomized controlled trial. During this waiting list period, patients are randomized and either (1) receive an internet-based guided self-help treatment or (2) receive a self-help book. The 5-week internet-based guided self-help intervention and the self-help booklet are based on problem solving treatment. After the intervention, patients are allowed to start regular face-to-face treatment at MHCs. Costs and effects are measured at baseline, after the intervention at 6 to 8 weeks, 6 months and 12 months. The primary outcome measure is symptoms of depression. Secondary outcome measures are diagnosis of depression, number of face-to-face sessions, absence of work and healthcare uptake in general. Additional outcome measures are anxiety, insomnia, quality of life and mastery.
  
  
  CONCLUSIONS
  This study evaluates the effectiveness and cost effectiveness of internet-based guided self-help in patients at specialized mental health centers. The aim is to demonstrate whether the introduction of internet-based self-help interventions in regular mental healthcare for depressive disorders can maintain clinical effects and reduce costs. Strengths and limitations of this study are discussed.
  
  
  BACKGROUND
  Netherlands Trial Register NTR2824.
authors.affiliation: Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. robin.kenter@vu.nl.
authors.forename: Robin Maria Francisca
authors.initials: RM
authors.lastname: Kenter
authors.forename: Annemieke
authors.initials: A
authors.lastname: van Straten
authors.forename: Sabine Heleen
authors.initials: SH
authors.lastname: Hobbel
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.forename: Judith
authors.initials: J
authors.lastname: Bosmans
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D020407:Internet; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011613:Psychotherapy; D011788:Quality of Life; D018401:Sample Size; D013813:Therapy, Computer-Assisted; D014850:Waiting Lists