title: Internet-based therapy for mild to moderate depression in Swedish primary care: short term results from the PRIM-NET randomized controlled trial.
abstract: Depression presents a serious condition for the individual and a major challenge to health care and society. Internet-based cognitive behavior therapy (ICBT) is a treatment option supported in several trials, but there is as yet a lack of effective studies of ICBT in "real world" primary care settings. We examined whether ICBT differed from treatment-as-usual (TAU) in reducing depressive symptoms after 3 months. TAU comprised of visits to general practitioner, registered nurse, antidepressant drugs, waiting list for, or psychotherapy, or combinations of these alternatives. Patients, aged ≥ 18 years, who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview. A total of 90 patients were randomized to either TAU or ICBT. The ICBT treatment included interactive elements online, a workbook, a CD with mindfulness and acceptance exercises, and minimal therapist contact. The treatment period lasted for 12 weeks after which both groups were assessed. The main outcome measure was Beck Depression Inventory-II (BDI-II). Additional measures were Montgomery Åsberg Depression Rating Scale - self rating version (MADRS-S) and Beck Anxiety Inventory (BAI). The analyses revealed no significant difference between the two groups at post treatment, neither on BDI-II, MADRS-S, nor BAI. Twenty patients (56%) in the ICBT treatment completed all seven modules. Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness, after 3 months, is at par with TAU.
authors.affiliation: a Department of Psychology , University of Gothenburg , Gothenburg , Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Kivi
authors.forename: Maria C M
authors.initials: MC
authors.lastname: Eriksson
authors.forename: Dominique
authors.initials: D
authors.lastname: Hange
authors.forename: Eva-Lisa
authors.initials: EL
authors.lastname: Petersson
authors.forename: Kristofer
authors.initials: K
authors.lastname: Vernmark
authors.forename: Boo
authors.initials: B
authors.lastname: Johansson
authors.forename: Cecilia
authors.initials: C
authors.lastname: Björkelund
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D010349:Patient Compliance; D011320:Primary Health Care / Q000379:methods*; D013548:Sweden; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D055815:Young Adult
keywords: ICBT; Internet-based treatment; depression; effectiveness; primary care; randomized controlled trial