title: The 6-month effectiveness of Internet-based guided self-help for depression in adults with Type 1 and 2 diabetes mellitus.
abstract: The aim of this research is to examine the 6-month effects of an Internet-based guided self-help intervention for comorbid depressive symptoms in people with diabetes.
  
  
  
  Participants (n = 260) with Type 1 or 2 diabetes and elevated depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) ≥ 23] were randomly assigned to a guided Internet-based self-help intervention or a control condition (treatment as usual + online psychoeducation about depression). The primary outcome was a change in depressive symptom severity (CES-D) from baseline to 6-month follow-up. The secondary outcomes included numbers of people achieving treatment response (reliable change of depressive symptoms) and remission (CES-D ≤ 16), as well as the effects on glycaemic control, diabetes-related emotional distress and diabetes acceptance. Repeated measures analysis of variance examined between-group differences using intent-to-treat principles.
  
  
  
  Both conditions showed improvements in depression severity: intervention condition, d = 1.48 [95% confidence interval (95% CI): 1.21 to 1.76]; control condition d = 0.55 (95% CI: 0.30 to 0.80). Changes were significantly greater in the intervention condition with a large between-group effect size (d = 0.83, 95% CI: 0.57 to 1.08). Accordingly, effects on response [relative risk (RR) = 2.60 (95% CI: 2.01 to 3.36), P < 0.001] and remission [RR = 3.36 (95% CI: 2.98 to 5.44), P < 0.001] were in favour of the intervention group, as were differences in change in diabetes emotional distress (d = 0.50, 95% CI: 0.04 to 0.54), and physical and mental functioning [Short Form Health Survey (SF-12) Physical d = 0.27 (95% CI: 0.01 to 0.51) and SF-12 Mental d = 0.68 (95% CI: 0.11 to 0.40)]. The intervention group was not superior with regard to glycaemic control, diabetes self-management and diabetes acceptance.
  
  
  
  The trial indicates that Internet-based guided self-help treatments for depression in people with diabetes can have sustained effects on depressive symptoms, well-being and emotional distress associated with diabetes.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.|Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany.|Department for Health Care Policy, Harvard University, Boston, MA, USA.
authors.forename: D D
authors.identifier: 0000-0001-6820-0146
authors.initials: DD
authors.lastname: Ebert
authors.affiliation: Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Nobis
authors.affiliation: Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Lehr
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Baumeister
authors.affiliation: Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany.|Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Riper
authors.affiliation: Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Auerbach
authors.affiliation: Department of Medical Psychology, VU University Medical Centre and Academic Medical Center, Amsterdam, The Netherlands.|Institute for Health and Care Research (EMGO), VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Snoek
authors.affiliation: Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany.|Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.|Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Berking
mesh_terms: D001521:Behavior Therapy; D003863:Depression / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D057194:Intention to Treat Analysis; D020407:Internet; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010353:Patient Education as Topic; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D000073278:Self-Management; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control
chemical_list: D007004:Hypoglycemic Agents