Anna S. Geraedts

Interpersonal Psychotherapy for Depression: A Meta-Analysis

OBJECTIVE Interpersonal psychotherapy (IPT), a structured and time-limited therapy, has been studied in many controlled trials. Numerous practice guidelines have recommended IPT as a treatment of choice for unipolar depressive disorders. The authors conducted a meta-analysis to integrate research on the effects of IPT. METHOD The authors searched bibliographical databases for randomized controlled trials comparing IPT with no treatment, usual care, other psychological treatments, and pharmacotherapy as well as studies comparing combination treatment using pharmacotherapy and IPT. Maintenance studies were also included. RESULTS Thirty-eight studies including 4,356 patients met all inclusion criteria. The overall effect size (Cohens d) of the 16 studies that compared IPT and a control group was 0.63 (95% confidence interval [CI]=0.36 to 0.90), corresponding to a number needed to treat of 2.91. Ten studies comparing IPT and other psychological treatments showed a nonsignificant differential effect size of 0.04 (95% CI=-0.14 to 0.21; number needed to treat=45.45) favoring IPT. Pharmacotherapy (after removal of one outlier) was more effective than IPT (d=-0.19, 95% CI=-0.38 to -0.01; number needed to treat=9.43), and combination treatment was not more effective than IPT alone, although the paucity of studies precluded drawing definite conclusions. Combination maintenance treatment with pharmacotherapy and IPT was more effective in preventing relapse than pharmacotherapy alone (odds ratio=0.37; 95% CI=0.19 to 0.73; number needed to treat=7.63). CONCLUSIONS There is no doubt that IPT efficaciously treats depression, both as an independent treatment and in combination with pharmacotherapy. IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression.

Psychological treatment of depressive symptoms in patients with medical disorders: A meta-analysis

OBJECTIVE It is widely acknowledged that the prevalence of depression in the general population is high, but that it is even higher for patients with medical disorders. Yet, the effectiveness of psychological treatments in these patient populations has not been firmly established. METHODS We conducted a meta-analysis of randomized controlled studies examining the effects of psychological treatments in patients with 1 of 10 different medical disorders and elevated levels of depression. Extensive searches were performed in PubMed, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials. RESULTS We included 23 studies. The overall effect size of the 15 studies that compared psychological treatments with a waitlist or care-as-usual control group was d=1.00 [95% confidence interval (CI), 0.57-1.44] but declined to d=0.42 (95% CI, 0.27-0.58) after removing two outliers with extremely high effects. We tested the type of disorder, inclusion based on diagnostic criteria or symptoms, type of treatment, treatment format, type of control group, and intention-to-treat or completers analyses, but none of these variables were significantly associated with the effect. The four studies that compared one type of psychotherapy to another showed a positive effect of cognitive behavioral therapy and interpersonal therapy compared to supportive therapy (d=0.42; 95% CI, 0.14-0.69). There were not enough studies (n=3) to draw any conclusions about the comparison of psychotherapy to pharmacotherapy. CONCLUSION We conclude that the effects of psychological treatment of patients with medical disorders are very similar to those found in otherwise healthy patients. Treating this comorbid depression should be one of the priorities in medical care settings.

Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial

Background Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms via the Internet before they report sick from work could be beneficial and cost saving. Objective In this study, we tested the effectiveness over the period of 1 year of a Web-based guided self-help intervention, called Happy@Work, for employees with depressive symptoms who were not on sick leave. Methods A two-arm randomized controlled trial comparing a worker-directed, Web-based, guided self-help intervention to care as usual (CAU) was carried out. We recruited employees from 6 companies via the company’s Intranet and by putting up posters. The inclusion criteria were elevated depressive symptoms as measured by a score ≥16 on the Center for Epidemiologic Studies Depression scale (CES-D) and not being on sick leave. The intervention contained 6 lessons and consisted of problem-solving treatment and cognitive therapy. Participants were asked to submit weekly assignments via the website after completion of a lesson and they received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), burnout (Maslach Burnout Inventory, MBI), work performance (Health and Work Performance Questionnaire, HPQ), duration of absenteeism, and anxiety (Hospital Anxiety and Depression Scale, HADS; secondary outcomes), were completed at baseline, posttreatment, and at 6-, and 12-month follow-up. Several subgroup and per-protocol analyses were performed. Results A total of 231 employees were randomized to either the intervention group (n=116) or to CAU (n=115). Completion of assessments varied between 54%-74%. Improvement in depressive symptoms between baseline and posttreatment was shown in all participants and these effects sustained over time. However, there were no differences between the 2 groups (adjusted regression coefficient=0.46, 95% CI –2.11 to 3.03, P=.72; Cohen’s d=0.05). Differences between groups were also not significant for the secondary outcomes. No subgroups were identified to show differences between the groups, nor did we find a between-group effect in the per-protocol analyses. Conclusions This study showed that a worker-directed, Web-based, guided self-help intervention was not more effective than CAU in reducing depressive symptoms among employees with depressive symptoms who were not on sick leave over the period of 1 year. An intervention for this specific target group might not be necessary because the recovery in the CAU group was comparable to the intervention group and sustained over a 12-month period. Trial Registration Nederlands Trial Register (NTR): NTR2993; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2993 (Archived by WebCite at http://www.webcitation.org/6PL9pFC0n).

Economic Evaluation of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Results of a Randomized Controlled Trial.

Objective: To evaluate the cost-effectiveness of a Web-based guided intervention compared with care as usual for employees with depressive symptoms. Methods: A total of 231 employees with depressive symptoms were randomized. Data were collected at baseline, 8 weeks, 6 months, and 12 months. Analyses were conducted from the societal and employers perspective. Results: At 12 months, a significant intervention effect on depressive symptoms was found. At a willingness to pay of 0 (&OV0556;/unit of effect), the interventions probabilities of cost-effectiveness were 0.62 (societal perspective) and 0.55 (employers perspective). There was a 0.63 probability that the intervention resulted in a positive financial return for the employer. Conclusions: The interventions cost-effectiveness with regard to depressive symptoms depends on the willingness to pay of societal and company decision makers as well as the probability of cost-effectiveness that they consider acceptable. The intervention is not cost-saving to the employer.

Web-based guided self-help for employees with depressive symptoms (Happy@Work): design of a randomized controlled trial

BackgroundDepressive disorders are highly prevalent in the working population and are associated with excessive costs for both society and companies. Effective treatment for employees with depressive symptoms in occupational health care is limited. The purpose of this study is to investigate the effectiveness and cost-effectiveness of an indicated preventive web-based guided self-help course for employees with depressive symptoms.MethodsThe study is a two-arm randomized controlled trial comparing a web-based guided self-help course with care-as-usual. The self-help course consists of 6 weekly lessons. Weekly support will be provided by a coach via the website. Subjects in the care-as-usual group do not receive any treatment in addition to regular care. 200 white collar workers from several national and international companies in the Netherlands will be recruited via different methods such as banners on the company’s intranet, pamphlets and posters. Subjects will be included when they: have elevated depressive symptoms (score ≥16 on the Center for Epidemiologic Studies Depression scale), are 18 years of age or older, have access to the Internet and can be contacted via e-mail. Exclusion criteria are: partial or full work absenteeism, a legal labor dispute with the employer and receiving treatment from the company’s occupational health care at study entrance.The primary outcome is depressive symptoms. Secondary outcomes include work absenteeism, work performance, burnout, anxiety, quality of life, health care use and production losses. Outcome data will be collected at 8 weeks, 6 months, and 12 months after baseline. Analyses will be based on the intention-to-treat principle. The cost-effectiveness analyses will be performed from a societal and a company’s perspective. A process evaluation will be conducted alongside the study.DiscussionThis study evaluates the effectiveness and cost-effectiveness of a web-based guided self-help course for employees with depressive symptoms. This study could stimulate the use of e-mental health interventions in the worksite setting.Trial registrationNederlands Trial Register (NTR): TC2993

Occupational e-Mental Health: Current Approaches and Promising Perspectives for Promoting Mental Health in Workers

During the past few years, the Internet has started to change lifestyles and affect all life domains, including working life. It is also increasingly used for targeting mental health issues. The “application of information technology in mental and behavioral health” (Andersson G, Riper H, Carlbring P (2014) Editorial: Introducing Internet interventions—a new open access journal. Internet Intervent 1:1–2) is becoming common in health-care; interventions have already been incorporated into routine care in countries such as the Netherlands, Sweden, the UK, Australia, and the USA. As a next step, Internet interventions in the area of occupational health are progressively emerging. They may offer an evidence-based, cost-effective, and convenient way of promoting workers’ mental health on a large scale. Currently, Internet interventions for workers are the most promising approach in the field of occupational e-mental health. The evolution of occupational e-mental health is embedded in interdisciplinary research, practice, and policy. In the first section of this chapter, the origins of occupational e-mental health will be outlined and a definition proposed. Following this, different approaches to occupational e-mental health will be described and their potentials elucidated. A comparison between Internet interventions and traditional stress-management trainings will provide further insights into the design and characteristics of the most elaborated approach in occupational e-mental health. Subsequently, various Internet training programs will be introduced and the evidence for their efficacy summarized. Finally, important topics for further research and implementation will be outlined.

Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis

There is limited evidence on the cost effectiveness of Internet‐based treatments for depression. The aim was to evaluate the cost effectiveness of guided Internet‐based interventions for depression compared to controls.

The Longitudinal Prediction of Costs due to Health Care Uptake and Productivity Losses in a Cohort of Employees With and Without Depression or Anxiety

Objective: To examine how various predictors and subgroups of respondents contribute to the prediction of health care and productivity costs in a cohort of employees. Methods: We selected 1548 employed people from a cohort study with and without depressive and anxiety symptoms or disorders. Prediction rules, using the RuleFit program, were applied to identify predictors and subgroups of respondents, and to predict estimations of subsequent 1-year health care and productivity costs. Results: Symptom severity and diagnosis of depression and anxiety were the most important predictors of health care costs. Depressive symptom severity was the most important predictor for productivity costs. Several demographic, social, and work predictors did not predict economic costs. Conclusions: Our data suggest that from a business perspective it can be beneficial to offer interventions aimed at prevention of depression and anxiety.

Internet-based stress management for distressed managers: results from a randomised controlled trial

Objective The aim of this randomised controlled trial (RCT) was to evaluate the efficacy of a guided internet-based stress management intervention (iSMI) among distressed managers compared with a attention control group (AC) with full access to treatment-as-usual. Method A total sample of 117 distressed managers, mainly employed in the healthcare, IT, communication and educational sector, were randomised to either iSMI (n=59) or an AC group (n=58). The iSMI consisted of eight modules including cognitive behavioural stress management and positive management techniques. Participants received a minimal and weekly guidance from a psychologist or master-level psychology student focusing on support, feedback and adherence to the intervention. Self-report data were assessed at pre, post and 6 months after the intervention. The primary outcome was perceived stress (Perceived Stress Scale-14). The secondary outcomes included mental and work-related health outcomes. Results Participants in the iSMI intervention reported significantly less symptoms of perceived stress (d=0.74, 95% CI 0.30 to 1.19) and burnout (d=0.95, 95% CI 0.53 to 1.37) compared with controls, at postassessment. Significant medium-to-large effect sizes were also found for depression, insomnia and job satisfaction. Long-term effects (6 months) were seen on the mental health outcomes. Conclusion This is one of the first studies showing that iSMIs can be an effective, accessible and potentially time-effective approach of reducing stress and other mental-related and work-related health symptoms among distressed managers. Future studies are needed addressing distressed managers and the potential of indirect effects on employee stress and satisfaction at work.