Research report
Increasing the acceptance of internet-based mental health interventions in primary care patients with depressive symptoms. A randomized controlled trial

https://doi.org/10.1016/j.jad.2015.01.056Get rights and content

Abstract

Background

Internet-based interventions (IBI) are effective in treating depression. However, uptake rates in routine care are still limited. Hence, this study aimed to (1) assess the acceptance of IBIs in primary care patients with depressive symptoms and to (2) examine the effects of a brief acceptance facilitating intervention in the form of an informational video on patients׳ acceptance of IBIs.

Methods

Primary care patients (N=128) with Minor or Major Depression were randomly assigned to an intervention (IG) or control group (CG). Patients in the IG were shown a brief informational video about IBIs before receiving a questionnaire that assessed their acceptance of IBIs and other secondary outcomes. Patients of the CG filled out the questionnaire immediately.

Results

Baseline acceptance of IBIs in the CG was high for 6.3%, moderate for 53.1% and low for 40.6% of patients. Acceptance of IBIs was significantly higher in the IG when compared to the CG (d=.71, 95%–CI:.09–2.91). Except for social influence and the general attitude towards psychological treatment, all secondary outcomes were also significantly improved (e.g. effort- (d=.40) and performance-expectancy: d=.65; knowledge about Internet interventions d=.35).

Limitations

Depression of the participants was only assessed using a self-report measure (PHQ-9).

Conclusion

Primary care patients׳ acceptance of IBIs for depressive symptoms was low but could be increased significantly using a brief acceptance facilitating intervention on the basis of an informational video. Future studies should further examine the potential of acceptance facilitating interventions for patients and health care providers to exploit the public health impact of IBIs.

Section snippets

Background

Depression is one of the most prevalent mental disorders with a lifetime prevalence rate of 16% and higher (Alonso et al., 2004, Kessler et al., 2001). It is associated with a considerable quality of life decrement (Ustün et al., 2004) and substantial economic costs (Berto et al., 2000, Luppa et al., 2007). Moreover, depression is expected to become the leading cause of disability in high-income countries by 2030 (Mathers and Loncar, 2006).

Psychotherapy is one of the established evidence-based

Design & procedure

This was an experimental study, with a parallel group design in 128 primary care patients. Participants were randomly assigned to the intervention group (IG) or the control group (CG) in a 1:1 ratio. Participants were recruited in Germany by two independent research assistants from May 2014 to June 2014 in two different medical practices in Germany. To be eligible for the study, participants were required to (a) be waiting for a scheduled treatment appointment in a waiting room of one of the

Results

Fig. 1 shows participant enrollment and flow throughout the study. Our final sample of 128 primary care patients were randomized to either the intervention or control group.

Discussion

The present work is one of the few studies investigating the acceptance of IBIs in primary care patients with depressive symptoms. Moreover, to our knowledge, the present study is the first to examine effects of an AFI consisting of a short informational video on patients׳ acceptance of IBIs in this population.

Acceptance rates in the CG indicate a relatively low acceptance of IBIs in depressed primary care patients, with 93.7% percent of the sample displaying only low to moderate acceptance.

Funding

This study as partly supported by a grant from the European Union (EFRE: ZW6-80119999, CCI 2007DE161PR001). Role of funding source: The funders played no role in study design, collection, analysis, interpretation of data, writing of the report, or in the decision to submit the paper for publication.

Author contributions

Designed the experiments, analyzed the data: DDE. Contributed to the design and analyses: MP. Contributed to the design: HB. Wrote the first draft of the manuscript: DDE, HB. All authors contributed to the interpretation of the data and the further writing of the manuscript: All authors. All authors agree with manuscript results and conclusions.

Competing Interests

There are no competing interests.

Acknowledgments

We would like to thank Sebastian Molkenbur and Bernhard Sieland for their help in developing the AFI and Franziska Gröner for her support in conducting the study.

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