Abstract
Background.
Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost-) effectiveness of online computerised cognitive behavioural therapy for depression in primary care.
Methods/Design.
In a randomised trial we will compare (a) computerised cognitive behavioural therapy with (b) treatment as usual by a GP, and (c) computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18-65) will be recruited in the general population by means of a large-scale Internet-based screening (N = 200,000). Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life.
Discussion.
Although computerised cognitive behavioural therapy is a promising treatment for depression in primary care, more research is needed. The effectiveness of online computerised cognitive behavioural therapy without support remains to be evaluated as well as the effects of computerised cognitive behavioural therapy in combination with usual GP care. Economic evaluation is also needed. Methodological strengths and weaknesses are discussed. Trial registration. The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).
Original language | English |
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Article number | 224 |
Number of pages | 11 |
Journal | BMC Public Health |
Volume | 8 |
DOIs | |
Publication status | Published - 2008 |
Externally published | Yes |
Bibliographical note
Funding Information:We thank Annie Hendriks and Greet Kellens for their assistance during the study. Rosanne Janssen develops the infrastructure for the online data-collection. The Pandora foundation has a consultative role. The trial is financed by ZonMw (Netherlands Organisation for Health Research and Development; project number 945-04-417), research institute Experimental Psychopathology (EPP) and the Care And Public Health Research Institute (CAPHRI). Municipalities Eijsden, Meerssen, Sittard-Geleen, Valkenburg, and Maastricht sponsor the study.
Funding
We thank Annie Hendriks and Greet Kellens for their assistance during the study. Rosanne Janssen develops the infrastructure for the online data-collection. The Pandora foundation has a consultative role. The trial is financed by ZonMw (Netherlands Organisation for Health Research and Development; project number 945-04-417), research institute Experimental Psychopathology (EPP) and the Care And Public Health Research Institute (CAPHRI). Municipalities Eijsden, Meerssen, Sittard-Geleen, Valkenburg, and Maastricht sponsor the study.