Web-Based Depression Treatment for Type 1 and Type 2 Diabetic Patients
A randomized, controlled trial
- Kim M.P. van Bastelaar, MSC1,2,
- François Pouwer, PHD3,
- Pim Cuijpers, PHD2,4,
- Heleen Riper, PHD5 and
- Frank J. Snoek, PHD1,2
- 1Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
- 2Institute for Health and Care Research (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands
- 3Department of Medical Psychology & Neuropsychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
- 4Department of Clinical Psychology, VU University, Amsterdam, the Netherlands
- 5Netherlands Institute of Mental Health and Addiction (Trimbos), Utrecht, the Netherlands.
- Corresponding author: Kim M.P. van Bastelaar,
OBJECTIVE Comorbid depression is common in patients with type 1 and type 2 diabetes, adversely affecting quality of life, diabetes outcomes, and mortality. Depression can be effectively treated with cognitive behavior therapy (CBT). The Internet is a new and attractive method for delivering CBT intervention on a large scale at relatively low costs. This study evaluated the effectiveness of Web-based CBT for depression treatment in adults with type 1 or type 2 diabetes, with minimal guidance.
RESEARCH DESIGN AND METHODS A randomized controlled trial was conducted in the Netherlands in 255 adult diabetic patients with elevated depressive symptoms. Primary outcomes were depressive symptoms. Secondary outcomes were diabetes-specific emotional distress and glycemic control. Assessments were at baseline, after treatment, and at the 1-month follow-up.
RESULTS The Web-based CBT was effective in reducing depressive symptoms by intention-to-treat analyses (P = 0.04, d = 0.29; clinical improvement 41% vs. 24% P < 0.001) and by per-protocol analyses (P < 0.001, d = 0.70; clinical improvement, 56% vs. 24% P < 0.001). The intervention reduced diabetes-specific emotional distress (P = 0.03) but had no beneficial effect on glycemic control (P > 0.05).
CONCLUSIONS Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes. In addition, the intervention reduces diabetes-specific emotional distress in depressed patients.
- Received July 1, 2010.
- Accepted October 22, 2010.
- © 2011 by the American Diabetes Association.
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