Internet-Delivered Cognitive Behavioural Therapy for Adults with Mild to Moderate Depression and High Cardiovascular Disease Risks: A Randomised Attention-Controlled Trial

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Abstract

Background and Aim

Mild to moderate depression is common in those with cardiovascular disease and undertreated. We aimed to evaluate the effectiveness of internet-delivered Cognitive Behaviour Therapy (iCBT) on depressive symptom severity and adherence to medical advice and lifestyle interventions in adults with mild to moderate depression and high cardiovascular disease (CVD) risks.

Methods

Randomised double-blind, 12 week attention-controlled trial comparing an iCBT programme ( E-couch) with an internet-delivered attention control health information package ( HealthWatch, n = 282). The primary outcome was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9) (trial registration: ACTRN12610000085077).

Results

487/562 (88%) participants completed the endpoint assessment. 383/562 (70%) were currently treated for cardiovascular disease and 314/562 (56%) had at least one other comorbid condition. In ITT analysis of 562 participants iCBT produced a greater decline in the mean PHQ-9 score compared to the attention control of 1.06 (95% CI: 0.23–1.89) points, with differences between the two arms increasing over the intervention period (time by treatment effect interaction p = .012). There were also larger improvements in adherence (2.16 points; 95% CI: 0.33–3.99), reductions in anxiety (0.96 points; 95% CI: 0.19–1.73), and a greater proportion engaging in beneficial physical activity (Odds Ratio 1.91, 95%CI: 1.01–3.61) in the iCBT participants but no effect upon disability, or walking time/day. There were no withdrawals due to study related adverse events.

Conclusions

In people with mild to moderate depression and high levels of CVD risk factors, a freely accessible iCBT programme ( http://www.ecouch.anu.edu.au) produced a small, but robust, improvement in depressive symptoms, adherence and some health behaviours.

Trial Registration

Australian and New Zealand Clinical Trials Registry ACTRN12610000085077

Related collections

Author and article information

Contributors

Gerhard Andersson: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 26 March 2013

Volume: 8

Issue: 3

Electronic Location Identifier: e59139

Affiliations

[1 ]Brain and Mind Research Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia

[2 ]Black Dog Institute, Sydney, New South Wales, Australia

[3 ]The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia

[4 ]Orygen Youth Health Research Centre, University of Melbourne, Melbourne, Victoria, Australia

Linkoping University, Sweden

Author notes

* E-mail: nick.glozier@ 123456sydney.edu.au

Competing Interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that HC was a co-developer of E-couch. The other authors have reported no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Conceived and designed the experiments: NG HC SN NC BN AM IH. Performed the experiments: NG HC SN NC LD BN IH. Analyzed the data: NG AM. Wrote the paper: NG HC SN NC LD BN AM IH.

Article

Publisher ID: PONE-D-12-36365

DOI: 10.1371/journal.pone.0059139

PMC ID: 3608590

PubMed ID: 23555624

SO-VID: 9e57b977-be59-4ec5-b567-b2ea229231ad

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 9 November 2012

Date accepted : 11 February 2013

Page count

Pages: 8

Funding

This trial was funded by the Cardiovascular Disease and Depression Strategic Research Program (No. G08S 4048) funded by the National Heart Foundation of Australia ( http://www.heartfoundation.org.au) and beyondblue: the national depression initiative ( http:www.beyondblue.org.au). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.