1 research outputs found
Randomized Controlled Trial
Background: Depression is highly prevalent in the working population and is
associated with significant loss of workdays; however, access to evidence-
based treatment is limited. Objective: This study evaluated the effectiveness
of a Web-based intervention in reducing mild to moderate depression and
sickness absence. Methods: In an open-label randomized controlled trial,
participants were recruited from a large-scale statutory health insurance and
were assigned to two groups. The intervention group had access to a 12 week
Web-based program consisting of structured interactive sessions and therapist
support upon request. The wait-list control group had access to unguided Web-
based psycho-education. Depressive symptoms were self-assessed at baseline,
post-treatment, and follow-up (12 weeks after treatment) using the Patient
Health Questionnaire (PHQ-9) and Beck Depression Inventory (BDI-II) as primary
outcome measures. Data on sickness absence was retrieved from health insurance
records. Intention-to-treat (ITT) analysis and per-protocol (PP) analysis were
performed. Results: Of the 180 participants who were randomized, 88 completed
the post-assessment (retention rate: 48.8%, 88/180). ITT analysis showed a
significant between-group difference in depressive symptoms during post-
treatment in favor of the intervention group, corresponding to a moderate
effect size (PHQ-9: d=0.55, 95% CI 0.25-0.85, P<.001, and BDI-II: d=0.41, CI
0.11-0.70, P=.004). PP analysis partially supported this result, but showed a
non-significant effect on one primary outcome (PHQ-9: d=0.61, 95% CI
0.15-1.07, P=.04, and BDI-II: d=0.25 95% CI −0.18 to 0.65, P=.37). Analysis of
clinical significance using reliable change index revealed that significantly
more participants who used the Web-based intervention (63%, 63/100) responded
to the treatment versus the control group (33%, 27/80; P<.001). The number
needed to treat (NNT) was 4.08. Within both groups, there was a reduction in
work absence frequency (IG: −67.23%, P<.001, CG: −82.61%, P<.001), but no
statistical difference in sickness absence between groups was found (P=.07).
Conclusions: The Web-based intervention was effective in reducing depressive
symptoms among adults with sickness absence. As this trial achieved a lower
power than calculated, its results should be replicated in a larger sample.
Further validation of health insurance records as an outcome measure for
eHealth trials is needed. Trial Registration: International Standard
Randomized Controlled Trial Number (ISRCTN): 02446836;
http://www.isrctn.com/ISRCTN02446836 (Archived by WebCite at
http://www.webcitation.org/6jx4SObnw