title: Short-term effects of a web-based guided self-help intervention for employees with depressive symptoms: randomized controlled trial.
abstract: BACKGROUND
  Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving.
  
  
  OBJECTIVE
  In this study, we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms. We report on the posttreatment effectiveness of the intervention.
  
  
  METHODS
  This study is a two-arm randomized controlled trial comparing a Web-based guided self-help course to care as usual (CAU). We recruited employees from 6 different companies via the companies' intranet and posters. The main inclusion criterion was elevated depressive symptoms as measured by a score of ≥16 on the Center for Epidemiological Studies Depression scale (CES-D). The intervention (Happy@Work) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons. Participants were asked to submit their weekly assignment via the website after completion. They subsequently received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), anxiety measured by the Hospital Anxiety and Depression Scale (HADS), burnout measured by the Maslach Burnout Inventory (MBI), and work performance measured by the Health and Work Performance Questionnaire (HPQ; secondary outcomes) were completed at baseline and at posttreatment.
  
  
  RESULTS
  A total of 231 employees were randomized to either the intervention group (n=116) or CAU (n=115).The posttreatment assessment was completed by 171 (74.0%) participants. Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms, but no differences between the conditions was found (d=0.16, 95% CI -0.10 to 0.41, P=.29). Significant but small effects in favor of the intervention group were found for anxiety symptoms (d=0.16, 95% CI -0.09 to 0.42, P=.04) and exhaustion (d=0.17, 95% CI -0.09 to 0.43, P=.02).
  
  
  CONCLUSIONS
  This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU. Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed.
authors.affiliation: VU University Amsterdam, Department of Clinical Psychology, Amsterdam, Netherlands. a.s.geraedts@vu.nl.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Geraedts
authors.forename: Annet M
authors.initials: AM
authors.lastname: Kleiboer
authors.forename: Noortje M
authors.initials: NM
authors.lastname: Wiezer
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services; D011340:Problem Solving; D012648:Self Care; D011795:Surveys and Questionnaires
keywords: depression, employees, occupational therapy, Internet, prevention