Lasse Sander

Effectiveness of Internet-Based Interventions for the Prevention of Mental Disorders: A Systematic Review and Meta-Analysis

Background Mental disorders are highly prevalent and associated with considerable disease burden and personal and societal costs. However, they can be effectively reduced through prevention measures. The Internet as a medium appears to be an opportunity for scaling up preventive interventions to a population level. Objective The aim of this study was to systematically summarize the current state of research on Internet-based interventions for the prevention of mental disorders to give a comprehensive overview of this fast-growing field. Methods A systematic database search was conducted (CENTRAL, Medline, PsycINFO). Studies were selected according to defined eligibility criteria (adult population, Internet-based mental health intervention, including a control group, reporting onset or severity data, randomized controlled trial). Primary outcome was onset of mental disorder. Secondary outcome was symptom severity. Study quality was assessed using the Cochrane Risk of Bias Tool. Meta-analytical pooling of results took place if feasible. Results After removing duplicates, 1169 studies were screened of which 17 were eligible for inclusion. Most studies examined prevention of eating disorders or depression or anxiety. Two studies on posttraumatic stress disorder and 1 on panic disorder were also included. Overall study quality was moderate. Only 5 studies reported incidence data assessed by means of standardized clinical interviews (eg, SCID). Three of them found significant differences in onset with a number needed to treat of 9.3-41.3. Eleven studies found significant improvements in symptom severity with small-to-medium effect sizes (d=0.11- d=0.76) in favor of the intervention groups. The meta-analysis conducted for depression severity revealed a posttreatment pooled effect size of standardized mean difference (SMD) =−0.35 (95% CI, −0.57 to −0.12) for short-term follow-up, SMD = −0.22 (95% CI, −0.37 to −0.07) for medium-term follow-up, and SMD = −0.14 (95% CI, -0.36 to 0.07) for long-term follow-up in favor of the Internet-based psychological interventions when compared with waitlist or care as usual. Conclusions Internet-based interventions are a promising approach to prevention of mental disorders, enhancing existing methods. Study results are still limited due to inadequate diagnostic procedures. To be able to appropriately comment on effectiveness, future studies need to report incidence data assessed by means of standardized interviews. Public health policy should promote research to reduce health care costs over the long term, and health care providers should implement existing, demonstrably effective interventions into routine care.

Allgemeine Wirkfaktoren bei der Behandlung chronisch depressiver Patienten – Vergleich zweier Psychotherapieansätze

Hintergrund: Das Ausmaß, in dem allgemeine Wirkfaktoren die Wirksamkeit von Psychotherapie bei chronischer Depression beeinflussen, ist bisher wenig untersucht: Welche allgemeinen Wirkfaktoren unterscheiden erfolgreiche und weniger erfolgreiche Psychotherapien bei chronisch depressiven Patienten? Patienten und Methoden: Mit Hilfe des Berner Patienten- und Therapeutenstundenbogens (TSTB/PSTB) wurden bei 29 chronisch depressiven Patienten während einer 16-wöchigen Behandlung mit dem Cognitive Behavioral Analysis System of Psychotherapy (CBASP) oder der Interpersonellen Psychotherapie (IPT) wöchentlich die Wirkfaktoren erhoben und mittels Varianzanalyse verglichen. Als primäres Erfolgsmaß diente die 24-Item Hamilton Depressionsskala (HRSD-24). Ergebnisse: Aus Patientensicht zeigten sich signifikante Unterschiede zwischen erfolgreichen (Response-Kriterium definiert als mindestens 50%-Verbesserung im HRSD-24) und weniger erfolgreichen Therapien im Ausmaß «Motivationaler Klärung» (p = 0,02) und «Problembewältigung» (p = 0,01). Es konnten keine bedeutsamen Unterschiede bezüglich allgemeiner Wirkfaktoren von CBASP- versus IPT-Therapien nachgewiesen werden. Diskussion: Unabhängig von der spezifischen Therapiemethode bestätigt sich aus Patientensicht die Bedeutung intensiver Motivationaler Klärung sowie bewältigender Strategien für eine erfolgreiche Behandlung chronischer Depressionen.

Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial

Introduction Depression often co-occurs with chronic back pain (CBP). Internet and mobile-based interventions (IMIs) might be a promising approach for effectively treating depression in this patient group. In the present study, we will evaluate the effectiveness and cost-effectiveness of a guided depression IMI for individuals with CBP (eSano BackCare-D) integrated into orthopaedic healthcare. Methods and analysis In this multicentre randomised controlled trial of parallel design, the groups eSano BackCare-D versus treatment as usual will be compared. 210 participants with CBP and diagnosed depression will be recruited subsequent to orthopaedic rehabilitation care. Assessments will be conducted prior to randomisation and 9 weeks (post-treatment) and 6 months after randomisation. The primary outcome is depression severity (Hamilton Rating Scale for Depression-17). Secondary outcomes are depression remission and response, health-related quality of life, pain intensity, pain-related disability, self-efficacy and work capacity. Demographic and medical variables as well as internet affinity, intervention adherence, intervention satisfaction and negative effects will also be assessed. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Moreover, a cost-effectiveness and cost-utility analysis will be conducted from a societal perspective after 6 months. Ethics and dissemination All procedures are approved by the ethics committee of the Albert-Ludwigs-University of Freiburg and the data security committee of the German Pension Insurance (Deutsche Rentenversicherung). The results will be published in peer-reviewed journals and presented on international conferences. Trial registration number DRKS00009272; Pre-results.

Effectiveness of Internet- and mobile-based psychological interventions for the prevention of mental disorders: a systematic review and meta-analysis protocol

BackgroundDespite progress in developing technologies for health promotion and disease treatment, mental disorders remain highly prevalent. In light of the associated personal and societal burden, primary prevention of new onset disorder can be seen as a primary challenge for health care systems and society. Internet- and mobile-based interventions (IMIs) are a promising approach to scale up preventive measures to a population level. The present protocol describes the rationale and design of a systematic review on the effectiveness of IMIs for the prevention of mental disorders.Methods/designA systematic literature search (MEDLINE, PsycINFO, CENTRAL) will be conducted. Keywords will target the topics “prevention”, “mental disorders”, and “Internet and mobile-based interventions”. Studies eligible for inclusion will be retrieved, and data will be extracted and evaluated (design, population, outcomes, sample size, duration of intervention and follow-up, drop-out rate) by two independent researchers. Quality of evidence will be assessed, and results will be synthesized qualitatively and pooled meta-analytically when outcome data are comparable in terms of endpoints, assessments, and target disorders.DiscussionPrevention of mental disorders is one of the major emerging global health challenges. This review and meta-analysis will contribute to our understanding of the potential role for IMIs to help address this challenge.Systematic review registrationPROSPERO CRD42015026781

«Hilfe aus dem App-Store?»: Eine systematische Übersichtsarbeit und Evaluation von Apps zur Anwendung bei Depressionen

Hintergrund: In Deutschland sind etwa 4,9 Millionen Menschen an Depressionen erkrankt. Depressionen sind für die Betroffenen und die Gesellschaft mit enormen Belastungen verbunden. Gesundheits-Apps haben hier das Potenzial, die Versorgungslage zu verbessern. Das Ziel dieser systematischen Übersichtsarbeit ist es, die Qualität, Inhalte und Praxisrelevanz von deutschsprachigen Apps für die Anwendung bei Depressionen zu untersuchen. Methode: Die deutschen Google-Play- und iTunes-Stores wurden systematisch nach Apps durchsucht, die explizit mit der Thematik «Depression/Depressivität» warben. Die so ermittelten Apps wurden mithilfe einer Skala zur Einschätzung der Qualität (Mobile Application Rating Scale) von 2 unabhängigen Gutachtern bewertet. Apps mit überdurchschnittlichem Rating wurden von 2 praktisch tätigen Verhaltenstherapeuten im Hinblick auf ihren Nutzen für die klinische Praxis beurteilt. Ergebnisse: Von 1156 identifizierten Apps wurden 38 eingeschlossen. Inhaltlich reichten diese von Informations- bis zu Interventions-Apps. Die Apps wiesen eine mittlere Gesamtqualität auf (M = 3,01; Standardabweichung = 0,56). Vier Apps zeigten überdurchschnittliche Werte. Sie wurden durch 2 Psychotherapeuten getestet und als bedingt empfehlenswert für die klinische Praxis beurteilt. Zu keiner der eingeschlossenen Apps konnte eine Wirksamkeitsstudie gefunden werden. Schlussfolgerungen: Deutschsprachige Depressions-Apps weisen qualitative Mängel auf. Zusätzlich fehlt es an klinischen Studien zum Nutzen und zu Risiken, weshalb der Einsatz in der klinischen Praxis nur bedingt empfohlen werden kann. Ein Gütesiegel für qualitativ hochwertige und praxisrelevante Gesundheits-Apps könnte Nutzer vor Fehlinformationen und Missbrauch schützen und Leistungserbringern den Einsatz digitaler Medien substanziell erleichtern.

Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research

Background Mental disorders are characterized by a high likelihood of recurrence. Thus, aftercare and follow-up interventions aim to maintain treatment gains and to prevent relapse. Internet- and mobile-based interventions (IMIs) may represent promising instruments in tertiary prevention. This systematic review summarizes and evaluates the research on the efficacy of IMIs as aftercare or follow-up interventions for adults with mental health issues. Methods A systematic database search (PsycInfo, MEDLINE, CENTRAL) was conducted and studies selected according to predefined eligibility criteria (RCTs, adult population, clinical symptoms/disorder, assessed with validated instruments, clinical-psychological intervention rationale, aftercare/follow-up intervention, web-/mobile-based, minimum follow-up measurement of three months, inclusion of a control group). Inspected outcomes were symptom severity, recurrence- and rehospitalization rates, functioning, quality of life and adherence to primary treatment. Systematic review registration: PROSPERO CRD42017055289. Results Sixteen RCTs met the inclusion criteria, covering trials on depression (n = 5), eating disorders (n = 4) and transdiagnostic interventions (n = 7). The majority of the interventions were based on Cognitive Behavioral Therapy (CBT) principles and were web-based (n = 11). Methodological quality of included studies was suboptimal. Limitations included attrition bias and non-specification of routine care co-interventions. IMIs yielded small to medium post-treatment effects for symptom severity (d = −0.08 – d = −0.45) in comparison to control groups. Best evidence base was found for symptom severity of depression and anxiety. Study results regarding recurrence and rehospitalization were inconsistent. Discussion There is some evidence, that IMIs are feasible instruments for maintaining treatment gains for some mental disorders. However, further high quality, large-scale trials are needed to expand research fields, improve adherence to and uptake of IMIs and facilitate implementation of effective interventions into routine care.

Internet- and mobile-based aftercare and follow-up for mental disorders: protocol of a systematic review and meta-analysis

Introduction Mental disorders are characterised by a high likelihood of symptom recurrence or chronicity. Thus, in the vulnerable post-discharge phase, aftercare and follow-up aim at stabilising treatment effects, promoting functionality and preventing relapse or readmission. Internet- and mobile-based interventions may represent low threshold and effective extensions to aftercare in tertiary prevention of mental disorders. Objectives The planned systematic review and meta-analysis aims to synthesise and analyse existing evidence on the effectiveness of psychological internet- and mobile-based aftercare or follow-up in maintaining treatment effects and/or preventing recurrence in adults with mental disorders. Methods and analysis Electronic databases (PsycInfo, MEDLINE and Cochrane Central Register of Controlled trials) will be searched systematically, complemented by a hand-search of ongoing trials and reference lists of selected studies. Data extraction and evaluation will be conducted by two independent researchersand quality will be assessed with the Cochrane risk of bias tool. Eligibility criteria for selecting studies will be: randomised controlled trials of internet-based and mobile-based, psychological aftercare and follow-up for the tertiary prevention of mental disorders in an adult population. Primary outcome will be symptom severity. Secondary outcomes will be symptom or disorder recurrence rate, rehospitalisation rate, functionality, quality of life or adherence to primary treatment. Further data items to be extracted will be: study design, intervention and technical characteristics, type of mental disorder or clinical symptom to be treated, target population items, setting, treatment engagement and assessment of additional outcome variables. Meta-analytic pooling will be conducted when data of included studies are comparable in terms of study design, intervention type, endpoints, assessments and target mental disorder. Cumulative evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. Ethics and dissemination Ethics approval is not required. Results from this review will be published in peer-reviewed journals and presented at international conferences. Trial registration number PROSPERO CRD42017055289.

Metadata (ORCID) Correction: Effectiveness of Internet-Based Interventions for the Prevention of Mental Disorders: A Systematic Review and Meta-Analysis

[This corrects the article DOI: 10.2196/mental.6061.].

Mütter und Töchter – eine Schicksalsgemeinschaft?

erhöhtes Risiko haben, eine depressive Episode selbst zu erleben. Es ist jedoch immer noch unklar, woher diese signifikante Erhöhung des Risikos rührt. In unserer Längsschnittstudie untersuchen wir Mädchen zwischen 9 und 14 Jahren, deren Mütter mehrere diagnostizierte klinische depressive Episoden während der Lebenszeit ihrer Töchter hatten, aber derzeit nicht depressiv sind. Die Töchter hingegen haben keine akute Störung und auch keine Geschichte psychischer Störungen. Wir vergleichen diese Risikogruppe mit gleichaltrigen Töchtern von Müttern ohne psychische Erkrankung. Die Töchter werden zum ersten Messzeitpunkt einer Reihe von Tests unterzogen: von Fragebögen über kognitive Experimente und biologische Maße der Stressreaktion bis hin zu einem funktionellen Magnetresonanztomographie (fMRT)Scan und genetischen Analysen. In jährlichen Abständen werden diese Töchter und ihre Mütter nachuntersucht. Diese Studie führe ich in Kollaboration mit Ian Gotlib an der Stanford University durch.

Richtlinien für Autoren

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