Major depressive disorder (MDD) involves low mood and related symptoms occurring on most days and persisting for at least two weeks.
MDD is associated with premature death and disability and with substantial economic burden. While treating MDD is important, attention has also been focused on its prevention in people with sub-threshold depression.
Sub-threshold depression refers to clinically significant symptoms of depression that do not meet the criteria for MDD. One intervention increasingly being used in the field of mental health is web-based therapies, which can remove some of the barriers that prevent people from seeking help.
Web-based interventions can be accessed by people anytime and anywhere, and remove the stigma barriers that deter some people from seeking help in-clinic. Previous research has shown that web-based interventions are effective in reducing depressive symptoms and have acceptable levels of usability.
Researchers investigated whether an online, guided self-help intervention could help prevent the onset of MDD in people with sub-threshold depression.
The study took place in Germany and participants were randomised to receive either enhanced usual care or the intervention. Enhanced usual care involved visits to a primary care clinician, in addition to a psychoeducational intervention that offered participants information about evidence-based treatments for depression.
The intervention arm received usual care in addition to an interactive online tool consisting of six 30 minute sessions that focussed on psychoeducation, behaviour therapy and problem-solving therapy. Participants in the intervention arm also had access to an online trainer who provided written individual feedback after each session.
The primary outcome measured was time to onset of MDD over a 12 month period. Self-reported clinical outcomes were also assessed including depressive symptom severity, functional impairment, anxiety, problem-solving skills, worrying and health care service uptake.
Participants receiving the online, interactive intervention had lower rates of MDD at 12 months compared to those in the enhanced usual care group. Improvements in self-reported clinical outcomes were also more favourable in the intervention group compared to the control group.
Implications
The results of this study suggest that an online, guided intervention could reduce the risk, or delay the onset, of MDD in people with sub-threshold depression.
There are a number of great online tools to manage depression including MindSpot and MoodGYM. Talk to your doctor about starting a program that best suits you.
If you are depressed, distressed or thinking of harming yourself, call Lifeline on 13 11 14 for free and confidential support.
