title: Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial.
abstract: BACKGROUND
  Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. We hypothesized that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults.
  
  
  METHODS
  This trial was controlled, randomized and assessor-blinded. Participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14) were recruited from clinical and non-clinical settings and randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity (PHQ-9). The main analysis was based on the intention-to-treat principle and used linear mixed models.
  
  
  RESULTS
  A total of 1,013 participants were randomized. Changes in PHQ-9 from baseline differed signixFB01;cantly between groups (t825 = 6.12, p < 0.001 for the main effect of group). The post-assessment between-group effect size in favour of the intervention was d = 0.39 (95% CI: 0.13-0.64). It was stable at follow-up, with d = 0.32 (95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10).
  
  
  CONCLUSIONS
  The Internet intervention examined in this trial was superior to CAU alone in reducing mild to moderate depressive symptoms. The magnitude of the effect is clinically important and has public health implications.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jan Philipp
authors.initials: JP
authors.lastname: Klein
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
authors.forename: Johanna
authors.initials: J
authors.lastname: Schröder
authors.forename: Christina
authors.initials: C
authors.lastname: Späth
authors.forename: Björn
authors.initials: B
authors.lastname: Meyer
authors.forename: Franz
authors.initials: F
authors.lastname: Caspar
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lutz
authors.forename: Alice
authors.initials: A
authors.lastname: Arndt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Greiner
authors.forename: Viola
authors.initials: V
authors.lastname: Gräfe
authors.forename: Martin
authors.initials: M
authors.lastname: Hautzinger
authors.forename: Kristina
authors.initials: K
authors.lastname: Fuhr
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.forename: Sandra
authors.initials: S
authors.lastname: Nolte
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
authors.forename: Gerhard
authors.initials: G
authors.lastname: Anderssoni
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.forename: Fritz
authors.initials: F
authors.lastname: Hohagen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016037:Single-Blind Method; D055815:Young Adult