title: Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial.
abstract: BACKGROUND
  Strategies to improve the life of patients suffering from recurrent major depression have a high relevance. This study examined the efficacy of 2 Internet-delivered augmentation strategies that aim to prolong symptom-free intervals.
  
  
  METHODS
  Efficacy was tested in a 3-arm, multicenter, open-label, evaluator-blind, randomized controlled trial. Upon discharge from inpatient mental health care, 232 adults with 3 or more major depressive episodes were randomized to 1 of 2 intervention groups (SUMMIT or SUMMIT-PERSON) or to treatment as usual (TAU) alone. Over 12 months, participants in both intervention arms received, in addition to TAU, intense monitoring via e-mail or a smartphone, including signaling of upcoming crises, assistance with personal crisis management, and facilitation of early intervention. SUMMIT-PERSON additionally offered regular expert chats. The primary outcome was 'well weeks', i.e. weeks with at most mild symptoms assessed by the Longitudinal Interval Follow-Up Evaluation, during 24 months after the index treatment.
  
  
  RESULTS
  SUMMIT compared to TAU reduced the time with an unwell status (OR 0.48; 95% CI 0.23-0.98) through faster transitions from unwell to well (OR 1.44; 95% CI 0.83-2.50) and slower transitions from well to unwell (OR 0.69; 95% CI 0.44-1.09). Contrary to the hypothesis, SUMMIT-PERSON was not superior to either SUMMIT (OR 0.77; 95% CI 0.38-1.56) or TAU (OR 0.62; 95% CI 0.31-1.24). The efficacy of SUMMIT was strongest 8 months after the intervention.
  
  
  CONCLUSIONS
  The fully automated Internet-delivered augmentation strategy SUMMIT has the potential to improve TAU by reducing the lifelong burden of patients with recurrent depression. The fact that the effects wear off suggests a time-unlimited extension.
authors.affiliation: Center for Psychotherapy Research, University of Heidelberg, Heidelberg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Kordy
authors.forename: Markus
authors.initials: M
authors.lastname: Wolf
authors.forename: Kai
authors.initials: K
authors.lastname: Aulich
authors.forename: Martin
authors.initials: M
authors.lastname: Bürgy
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.forename: Johannes
authors.initials: J
authors.lastname: Hüsing
authors.forename: Bernd
authors.initials: B
authors.lastname: Puschner
authors.forename: Christine
authors.initials: C
authors.lastname: Rummel-Kluge
authors.forename: Helmut
authors.initials: H
authors.lastname: Vedder
authors.forename: Matthias
authors.initials: M
authors.lastname: Backenstrass
mesh_terms: D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000628:therapy*; D019468:Disease Management; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D000068997:Smartphone; D017216:Telemedicine