STUDY | POPULATION CHARACTERISTICS (TREATMENT/CONTROL) | METHOD OF RECRUITMENT | INCLUSION AND EXCLUSION CRITERIA | INTERVENTION AND CONTROL (NO. OF SUBJECTS ENROLLED) | DURATION OF INTERVENTION; LENGTH OF FOLLOW-UP | OVERALL COMPLETION RATE | MEASURES OF OUTCOME AND RESULTS | LIMITS |
---|---|---|---|---|---|---|---|---|
Jamison and Scogin,21 1995 | Mean age: 37 y/39 y
Female: 75%/93% | Media announcements | HRSD, BDI, and DSM criteria used as inclusion criteria (all subjects were diagnosed with major depression)
Excluded: suicidal, psychotic, substance abuse, or other psychopathology | Intervention : minimal-contact CBT bibliotherapy with Feeling Good (40 subjects)
Control: waiting list (40 subjects) All subjects received weekly telephone calls | Read book in 4 wk
3-mo follow-up | 83% of treatment group and 98% of control group completed the 4-wk study | HRSD, BDI, DSM, SCL-90, ATQ, and DAS before, after, and at 3-mo follow-up
Treatment group had decrease in depressive symptoms, thoughts, attitudes (70% no longer met criteria for depression) Improvement maintained after 3 mo | Participants were self- selected; therefore, results might not be generalizable
Grade-6 reading skills required Short follow-up period |
Jacobs et al,22 2001 | Entire study group:
| Newspaper advertisements | Intake interview, using DSM criteria; included any presenting problems except substance abuse, severe mental disorder, or dementia | Intervention : computerized psychodynamic and CBT (Therapeutic Learning Program), overseen by therapist www.masteringstress.com (45 subjects)
Control: traditional short-term individual therapy (45 subjects) | 10 weekly sessions, or 10 wk of individual therapy; 6-mo follow-up | 91% of treatment group and 100% of control completed
90% of all subjects provided follow-up data | BDI, PSS, BSI, and STAI; all statistically significant reductions in both groups; all maintained at follow-up
Therapist GAF rating higher and more clinical change for patients in control group | Sample less pathological than general population; only some had depression
Possible therapist bias ranking individual therapy patients Note: control group received traditional psychotherapy |
Clarke et al,23 2002 | Mean age: 43 y/44 y
Female: 74%/77% | Recruitment brochures mailed to HMO members (equal no. of depressed and nondepressed patients) | Any person who accessed website and consented was enrolled | Intervention : interactive website using CBT (unattended), e-mailed reminders www.feelbetter.org (144 subjects)
Control: usual care in HMO (155 subjects) | 7 chapters and “Thought Helper” on-line as much as desired; assessed at 0, 4, 8, 16, and 32 wk | 74% of entire group completed at least 1 follow- up assessment; 59% at 32 wk
Average no. sign-ins: 2.6 | No effect across entire sample using CES-D scale
No difference in obtaining other mental health services Modest effect among persons reporting low levels of depression at intake | No clinical diagnosis of initial subjects
Infrequent patient use Some subjects more severely depressed than average population |
King et al,16 2002 | Patients:
| HADS at participating GPs offices | HADS criteria used as inclusion criteria
Excluded: organic brain syndromes, psychosis, learning disorders, unable to read English | Intervention : educational package on CBT to GPs, 4 half-days of training (42 GPs, 137 patients)
Control: usual care by GP (42 GPs, 135 patients) | Scale measures taken at 0, 3, and 6 mo following GP training | 60% GPs and 91% patients in treatment group
62% GPs and 90% patients in control group | BDI, STAI, SF-36, DAQ showed no change in patient outcomes
Slightly increased physician confidence in treatment group; treatment group physicians more likely to refer | Physicians did not get to choose patients they thought were suitable
Very depressed sample |
Proudfoot et al,24 2003 | Mean age: 44 y/46 y
Female: 74%/73% Taking medication: 43%/36% | Screening in GP waiting rooms and GP referral | Computerized intake interview and GHQ-12 used to include patients with depression or anxiety
Excluded: suicidal, psychotic, substance abuse, receiving counseling, taking medication for > 6 mo | Intervention : multimedia, interactive CBT computer program (Beating the Blues), overseen by GP weekly www.beatingtheblues.co.uk (77 subjects)
Control: treatment as usual (66 subjects) | 9 weekly sessions with assignments; scales before treatment; 1, 3, and 6-mo follow- up | 65% of treatment group and 77% of control group
62% of treatment group and 65% of control group provided 6-mo follow-up | BDI and WSAS showed significantly greater improvement in symptoms, work, and social adjustment; BDI reduced by 5 points (95% CI 2–9); WSAS reduced by 3 points (95% CI 0.5–6)
17% of treatment group and 31% of control group received posttrial counseling (unknown statistical significance) | Sample size too small to rule out interactions between treatment and medication
Authors have financial interest in website GPs must purchase software |
Christensen et al,17 2004 | Entire study group:
| Subjects randomly selected from electoral roll and mailed questionnaires | KPDS criteria used to include
Excluded if receiving care from psychologist or psychiatrist | Intervention 1: CBT website (MoodGYM) http://moodgym.anu.edu.au (182 subjects)
Intervention 2: educational website (BluePages) http://bluepages.anu.edu.au (165 subjects) Control: weekly discussion of lifestyle factors (178 subjects) All subjects received weekly telephone calls | 6 weekly sessions; post-intervention questionnaires done after sixth session | 66% of MoodGYM, 82% of BluePages, and 88% of control group completed treatment and posttreatment questionnaire | CES-D score decreased for both interventions equally
Based on ranking scales, MoodGYM reduced dysfunctional thinking and BluePages increased education regarding depression | No follow-up period was used to assess sustainability |
Andersson et al,18 2005 | Mean age: 36 y/36 y
Female: 78%/72% | Newspaper advertisement, press release | CIDI-SF and MADRS-S criteria used to include
Excluded: bipolar, psychosis, suicidal, new medication in last mo, history of CBT | Intervention: Internet-based CBT, Web-based discussion group, overseen by therapist who gave weekly feedback (57 subjects)
Control: waiting list, Web-based discussion group (60 subjects) | 5 modules to be completed (mean time of completion was 10 wk); 6-mo follow-up | 65% completed
63% of treatment group and 82% of control group provided posttreatment data 63% of treatment group and 58% of control group provided follow- up data | BDI showed significant (P = .007) improvement for treatment group
No difference on QoLI 233 Web-discussion postings for treatment group, 842 for control group Improvements somewhat maintained at follow-up | Medication status might have confounded results
Web-based discussions differed among groups Unclear what kind of feedback was provided by therapist |
Clarke et al,19 2005 | Mean age: 50 y/44 y/45 y
Female: 72%/83%/76% | Recruitment brochures mailed to HMO members (equal no. of depressed and nondepressed patients) | Any person who accessed website and consented was enrolled | Intervention 1: interactive website using CBT, postcard reminders www.feelbetter.org (75 subjects)
Intervention 2: interactive website using CBT, telephone reminders (80 subjects) Control: usual care in HMO (100 subjects) | 7 chapters and “Thought Helper” on-line as much as desired; reminders at 2, 8, and 13 wk; assessed at 0, 5, 10, and 16 wk | 82% of entire group completed at least 1 follow- up
Average no. sign- ins: 5.9 with postcards; 5.6 with telephone reminders | CES-D showed greater reductions in treatment group (20% more treatment subjects no longer met criteria for depression)
Reductions in CES-D more pronounced in those more severely depressed at baseline No significant effects on SF-12 or use of health care services | No clinical diagnosis of initial subjects
Short follow-up period |
Christensen et al,20 2006 | Entire study group:
| Spontaneous visitors to website recruited directly into trial | Any person who accessed website and consented was enrolled
Excluded if subject stated that physician had referred them to site | Intervention: 6 versions of CBT website modules compared (brief CBT; brief CBT and problem solving; brief CBT, stress, and problem solving; extended CBT and problem solving; extended CBT, behavioural strategies, and problem solving; full program) http://moodgym.anu.edu.au (2794 users)
Control: none No communication from study personnel | 19-wk recruitment period; 1–5 modules, depending on group; assessed before each module and after completion of last module | 20% of participants completed assigned intervention | GDS scores showed that extended CBT with or without behavioural strategies resulted in significant (P = .01) reduction of depression
Longer program— higher dropout rates | No clinical diagnosis of initial subjects
Lack of formal control group Sample might not be generalizable Poor retention (possibly owing to lack of contact with study personnel) |
ATQ—Automatic Thoughts Questionnaire, BDI—Beck Depression Inventory, BSI—Brief Symptom Inventory, CES-D—Center for Epidemiological Studies Depression Scale, CI—confidence interval, CIDI-SF—Composite International Diagnostic Interview Short-Form, DAQ—Depression Attitude Questionnaire, DAS—Dysfunctional Attitude Scale, DSM—Diagnostic and Statistical Manual of Mental Disorders, GAF—Global Assessment of Functioning, GDS—Goldberg Depression Scale, GHQ-12—General Health Questionnaire-12, HADS—Hospital Anxiety and Depression Scale, HMO—health maintenance organization, HRSD—Hamilton Rating Scale for Depression, KPDS—Kessler Psychological Distress Scale, MADRS-S—Montgomery-Asberg Depression Rating Scale–Self-rated, PSS—Perceived Stress Scale, QoLI—Quality of Life Inventory, SCL-90—Symptom Checklist-90, SF-12—measure of health-related functioning, SF-36—measure of quality of life, STAI—State-Trait Anxiety Inventory, WSAS—Work and Social Adjustment Scale.