Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Depression: HELP
Articles by David Daniel Ebert
Based on 49 articles published since 2008
||||

Between 2008 and 2019, D. D. Ebert wrote the following 49 articles about Depression.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Negative effects of psychotherapies for adult depression: A meta-analysis of deterioration rates. 2018

Cuijpers, Pim / Reijnders, Mirjam / Karyotaki, Eirini / de Wit, Leonore / Ebert, David D. ·Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands. Electronic address: p.cuijpers@vu.nl. · Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands. · Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. ·J Affect Disord · Pubmed #30005327.

ABSTRACT: BACKGROUND: The risk for deterioration in patients receiving psychotherapy for adult depression has not been examined extensively and it is not clear whether psychotherapy reduces this risk or may even increase it in some patients. We conducted a meta-analysis of trials comparing these psychotherapies with control conditions that report deterioration rates. METHODS: We used an existing database of randomized trials on psychotherapies for adult depression which was updated up to 1/1/2017, through systematic searches in bibliographic databases. We included trials that reported clinically significant deterioration rates. RESULTS: We included 18 studies with 23 comparisons between therapy and control groups. The pooled risk ratio of deterioration was 0.39 (95% CI: 0.27∼0.57), indicating that patients in the psychotherapy groups have a 61% lower chance to deteriorate than patients in the control groups. We found that 20 patients need to be treated with psychotherapy in order to avoid one case of deterioration, compared to the control conditions. The median deterioration rate in the therapy groups was 4%, and in some studies more than 10%, indicating that clinicians should always be aware of the risk of deterioration. LIMITATIONS: The results should be considered with caution because most studies had at least some risk of bias. Only 6% of all trials comparing psychotherapy with a control condition reported deterioration rates, using different ways to define deterioration which made pooling the prevalence rates across treatments and control groups impossible. CONCLUSIONS: Psychological treatments of adult depression may reduce the risk for deterioration, compared to control groups, but this should be considered with caution because of the small proportion of studies reporting deterioration rates.

2 Review Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. 2018

Karyotaki, Eirini / Ebert, David Daniel / Donkin, Liesje / Riper, Heleen / Twisk, Jos / Burger, Simone / Rozental, Alexander / Lange, Alfred / Williams, Alishia D / Zarski, Anna Carlotta / Geraedts, Anna / van Straten, Annemieke / Kleiboer, Annet / Meyer, Björn / Ünlü Ince, Burçin B / Buntrock, Claudia / Lehr, Dirk / Snoek, Frank J / Andrews, Gavin / Andersson, Gerhard / Choi, Isabella / Ruwaard, Jeroen / Klein, Jan Philipp / Newby, Jill M / Schröder, Johanna / Laferton, Johannes A C / Van Bastelaar, Kim / Imamura, Kotaro / Vernmark, Kristofer / Boß, Leif / Sheeber, Lisa B / Kivi, Marie / Berking, Matthias / Titov, Nickolai / Carlbring, Per / Johansson, Robert / Kenter, Robin / Perini, Sarah / Moritz, Steffen / Nobis, Stephanie / Berger, Thomas / Kaldo, Viktor / Forsell, Yvonne / Lindefors, Nils / Kraepelien, Martin / Björkelund, Cecilia / Kawakami, Norito / Cuijpers, Pim. ·Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands. Electronic address: e.karyotaki@vu.nl. · Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. · The Brain and Mind Research Institute, University of Sydney, NSW 2050, Australia. · Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands. · Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands. · Institute of Child Health, University College London, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden. · Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands. · Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands. · HumanTotalCare, Utrecht, the Netherlands. · Research Department, Gaia AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom. · Informatics Institute, Middle East Technical University, Ankara, Turkey. · Institute of Psychology, Leuphana University Lüneburg, Germany. · Department of Medical Psychology, VU Medical Center, Academic Medical Center, Public Health Research institute, Amsterdam, the Netherlands. · Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia. · Department of Behavioral Sciences and Learning, Linköping University, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden. · Brain and Mind Centre, University of Sydney, Sydney, Australia. · Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany. · Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia; The MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; School of Psychology, the University of New South Wales, Sydney, Australia. · Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, Hamburg, Germany. · Department of Medical Psychology, VU Medical Center, Amsterdam, the Netherlands. · Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan. · Department of Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden. · Oregon Research Institute, Eugene, OR, USA. · Department of Psychology, University of Gothenburg, Göteborg, Sweden. · MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Australia. · Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark. · Department of Behavioral Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden. · Department of Clinical Psychology, University of Bergen, Bergen, Norway. · Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia. · Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Germany. · Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. · Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden. · Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden. · Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ·Clin Psychol Rev · Pubmed #29940401.

ABSTRACT: Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.

3 Review Efficacy and moderators of psychological interventions in treating subclinical symptoms of depression and preventing major depressive disorder onsets: protocol for an individual patient data meta-analysis of randomised controlled trials. 2018

Ebert, David D / Buntrock, Claudia / Reins, Jo Annika / Zimmermann, Johannes / Cuijpers, Pim. ·Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany. · Institute of Psychology, Leuphana University of Luneburg, Luneburg, Germany. · Chair for Psychological Methods and Diagnostics, Psychologische Hochschule Berlin, Berlin, Germany. · Department of Clinical, Neuro and Developmental Psychology, EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands. ·BMJ Open · Pubmed #29549201.

ABSTRACT: INTRODUCTION: The long-term effectiveness of psychological interventions for the treatment of subthreshold depression and the prevention of depression is unclear and effects vary among subgroups of patients, indicating that not all patients profit from such interventions. Randomised clinical trials are mostly underpowered to examine adequately subgroups and moderator effects. The aim of the present study is, therefore, to examine the short-term and long-term as well as moderator effects of psychological interventions compared with control groups in adults with subthreshold depression on depressive symptom severity, treatment response, remission, symptom deterioration, quality of life, anxiety and the prevention of major depressive disorder (MDD) onsets on individual patient level and study level using an individual patient data meta-analysis approach. METHODS AND ANALYSIS: Systematic searches in PubMed, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials were conducted. We will use the following types of outcome criteria: (A) onset of major depression; (B) time to major depression onset; (C) observer-reported and self-reported depressive symptom severity; (D) response; (E) remission; (F) symptom deterioration; (G) quality of life, (H) anxiety; and (I) suicidal thoughts and behaviours. Multilevel models with participants nested within studies will be used. Missing data will be handled using a joint modelling approach to multiple imputation. A number of sensitivity analyses will be conducted in order test the robustness of our findings. ETHICS AND DISSEMINATION: The investigators of the primary trials have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment.This study will summarise the available evidence on the short-term and long-term effectiveness of preventive psychological interventions for the treatment of subthreshold depression and prevention of MDD onset. Identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised interventions for patients with subthreshold depression. PROSPERO REGISTRATION NUMBER: CRD42017058585.

4 Review Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis. 2018

Kolovos, Spyros / van Dongen, Johanna M / Riper, Heleen / Buntrock, Claudia / Cuijpers, Pim / Ebert, David D / Geraedts, Anna S / Kenter, Robin M / Nobis, Stephanie / Smith, Andrea / Warmerdam, Lisanne / Hayden, Jill A / van Tulder, Maurits W / Bosmans, Judith E. ·Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam, The Netherlands. · Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Nägelsbachstr, Erlangen, Germany. · ArboNed, Utrecht, The Netherlands. · Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany. · Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. · Stichting Benchmark GGZ (the Dutch Benchmark Foundation in Mental Health Care), Bilthoven, The Netherlands. ·Depress Anxiety · Pubmed #29329486.

ABSTRACT: BACKGROUND: 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. METHODS: Individual-participant data from five randomized controlled trials (RCT), including 1,426 participants, were combined. Cost-effectiveness analyses were conducted at 8 weeks, 6 months, and 12 months follow-up. RESULTS: The guided Internet-based interventions were more costly than the controls, but not statistically significant (12 months mean difference = €406, 95% CI: - 611 to 1,444). The mean differences in clinical effects were not statistically significant (12 months mean difference = 1.75, 95% CI: - .09 to 3.60 in Center for Epidemiologic Studies Depression Scale [CES-D] score, .06, 95% CI: - .02 to .13 in response rate, and .00, 95% CI: - .03 to .03 in quality-adjusted life-years [QALYs]). Cost-effectiveness acceptability curves indicated that high investments are needed to reach an acceptable probability that the intervention is cost effective compared to control for CES-D and response to treatment (e.g., at 12-month follow-up the probability of being cost effective was .95 at a ceiling ratio of 2,000 €/point of improvement in CES-D score). For QALYs, the intervention's probability of being cost effective compared to control was low at the commonly accepted willingness-to-pay threshold (e.g., at 12-month follow-up the probability was .29 and. 31 at a ceiling ratio of 24,000 and 35,000 €/QALY, respectively). CONCLUSIONS: Based on the present findings, guided Internet-based interventions for depression are not considered cost effective compared to controls. However, only a minority of RCTs investigating the clinical effectiveness of guided Internet-based interventions also assessed cost effectiveness and were included in this individual-participant data meta-analysis.

5 Review The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis. 2017

Heber, Elena / Ebert, David Daniel / Lehr, Dirk / Cuijpers, Pim / Berking, Matthias / Nobis, Stephanie / Riper, Heleen. ·Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany. · Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany. · Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom. · Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen Nuremberg, Erlangen, Germany. · Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. · Telepsychiatric Centre, University of Southern Denmark, Odense, Denmark. ·J Med Internet Res · Pubmed #28213341.

ABSTRACT: BACKGROUND: Stress has been identified as one of the major public health issues in this century. New technologies offer opportunities to provide effective psychological interventions on a large scale. OBJECTIVE: The aim of this study is to investigate the efficacy of Web- and computer-based stress-management interventions in adults relative to a control group. METHODS: A meta-analysis was performed, including 26 comparisons (n=4226). Cohen d was calculated for the primary outcome level of stress to determine the difference between the intervention and control groups at posttest. Analyses of the effect on depression, anxiety, and stress in the following subgroups were also conducted: risk of bias, theoretical basis, guidance, and length of the intervention. Available follow-up data (1-3 months, 4-6 months) were assessed for the primary outcome stress. RESULTS: The overall mean effect size for stress at posttest was Cohen d=0.43 (95% CI 0.31-0.54). Significant, small effects were found for depression (Cohen d=0.34, 95% CI 0.21-0.48) and anxiety (Cohen d=0.32, 95% CI 0.17-0.47). Subgroup analyses revealed that guided interventions (Cohen d=0.64, 95% CI 0.50-0.79) were more effective than unguided interventions (Cohen d=0.33, 95% CI 0.20-0.46; P=.002). With regard to the length of the intervention, short interventions (≤4 weeks) showed a small effect size (Cohen d=0.33, 95% CI 0.22-0.44) and medium-long interventions (5-8 weeks) were moderately effective (Cohen d=0.59; 95% CI 0.45-0.74), whereas long interventions (≥9 weeks) produced a nonsignificant effect (Cohen d=0.21, 95% CI -0.05 to 0.47; P=.006). In terms of treatment type, interventions based on cognitive behavioral therapy (CBT) and third-wave CBT (TWC) showed small-to-moderate effect sizes (CBT: Cohen d=0.40, 95% CI 0.19-0.61; TWC: Cohen d=0.53, 95% CI 0.35-0.71), and alternative interventions produced a small effect size (Cohen d=0.24, 95% CI 0.12-0.36; P=.03). Early evidence on follow-up data indicates that Web- and computer-based stress-management interventions can sustain their effects in terms of stress reduction in a small-to-moderate range up to 6 months. CONCLUSIONS: These results provide evidence that Web- and computer-based stress-management interventions can be effective and have the potential to reduce stress-related mental health problems on a large scale.

6 Review [Internet- and Mobile Based Psychotherapy for Depression]. 2017

Sander, Lasse / Ebert, David Daniel / Baumeister, Harald. ·Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg. · Lehrstuhl für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Erlangen-Nürnberg. · Abteilung für Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm. ·Fortschr Neurol Psychiatr · Pubmed #28114693.

ABSTRACT: Guided Internet- and mobile-based interventions (IMIs) are an effective and scientifically sound treatment option for depression. Meta-analyses revealed effect sizes comparable to those found for face-to-face treatment as well as pharmacotherapy. Today, most IMIs are based on cognitive behavioral therapy (CBT). While IMIs are well established in healthcare systems of many countries worldwide, Germany is still lagging behind. However, there are an increasing number of model projects trying to implement IMIs into routine healthcare for depression in Germany. Both, service providers and recipients would benefit from transparent quality assurance and data safety guidelines.

7 Review Using patient self-reports to study heterogeneity of treatment effects in major depressive disorder. 2017

Kessler, R C / van Loo, H M / Wardenaar, K J / Bossarte, R M / Brenner, L A / Ebert, D D / de Jonge, P / Nierenberg, A A / Rosellini, A J / Sampson, N A / Schoevers, R A / Wilcox, M A / Zaslavsky, A M. ·Department of Health Care Policy,Harvard Medical School,Boston, MA,USA. · Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE),University of Groningen, University Medical Center Groningen,Groningen,The Netherlands. · Department of Veterans Affairs,Office of Public Health,Washington, DC,USA. · VISN 19 Mental Illness Research Education and Clinical Center,University of Colorado,Anschutz Medical Campus,Anschulz, CO,USA. · Department of Psychiatry and Depression Clinical and Research Program,Harvard Medical School and Massachusetts General Hospital,Boston, MA,USA. · Department of Epidemiology,Janssen Research and Development,Titusville, NJ,USA. ·Epidemiol Psychiatr Sci · Pubmed #26810628.

ABSTRACT: BACKGROUNDS: Clinicians need guidance to address the heterogeneity of treatment responses of patients with major depressive disorder (MDD). While prediction schemes based on symptom clustering and biomarkers have so far not yielded results of sufficient strength to inform clinical decision-making, prediction schemes based on big data predictive analytic models might be more practically useful. METHOD: We review evidence suggesting that prediction equations based on symptoms and other easily-assessed clinical features found in previous research to predict MDD treatment outcomes might provide a foundation for developing predictive analytic clinical decision support models that could help clinicians select optimal (personalised) MDD treatments. These methods could also be useful in targeting patient subsamples for more expensive biomarker assessments. RESULTS: Approximately two dozen baseline variables obtained from medical records or patient reports have been found repeatedly in MDD treatment trials to predict overall treatment outcomes (i.e., intervention v. control) or differential treatment outcomes (i.e., intervention A v. intervention B). Similar evidence has been found in observational studies of MDD persistence-severity. However, no treatment studies have yet attempted to develop treatment outcome equations using the full set of these predictors. Promising preliminary empirical results coupled with recent developments in statistical methodology suggest that models could be developed to provide useful clinical decision support in personalised treatment selection. These tools could also provide a strong foundation to increase statistical power in focused studies of biomarkers and MDD heterogeneity of treatment response in subsequent controlled trials. CONCLUSIONS: Coordinated efforts are needed to develop a protocol for systematically collecting information about established predictors of heterogeneity of MDD treatment response in large observational treatment studies, applying and refining these models in subsequent pragmatic trials, carrying out pooled secondary analyses to extract the maximum amount of information from these coordinated studies, and using this information to focus future discovery efforts in the segment of the patient population in which continued uncertainty about treatment response exists.

8 Review Personalized Psychotherapy for Adult Depression: A Meta-Analytic Review. 2016

Cuijpers, Pim / Ebert, David D / Acarturk, Ceren / Andersson, Gerhard / Cristea, Ioana A. ·VU University Amsterdam, EMGO Institute for Health and Care Research, and Innovation Incubator. Electronic address: p.cuijpers@vu.nl. · Innovation Incubator and Friedrich-Alexander University Erlangen-Nüremberg. · Istanbul Sehir University. · Linköping University and Karolinska Institutet. · Babes-Bolyai University and University of Pisa. ·Behav Ther · Pubmed #27993344.

ABSTRACT: Personalized medicine is aimed at identifying which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two psychotherapies directly in a group of depressed patients with a specific characteristic. We focused on the six most examined types of psychotherapy for adult depression. Our searches resulted in 41 studies with 2,741 patients who met inclusion criteria. These 41 studies examined 27 specific characteristics of patients. Power calculations indicated that we would need 4 studies for each characteristic to find a clinically relevant effect size set at g = 0.50 and 16 studies for an effect size of 0.24. Only 3 patient characteristics were found to have sufficient power and to significantly moderate treatment outcomes. Cognitive-behavioral therapy was found to be more effective than other therapies in older adults (g = 0.29), in patients with comorbid addictive disorders (g = 0.31), and in university students (g = 0.46). Risk of bias was considerable in most of the included studies. It was estimated that it will take another 326 years to have sufficient statistical power for showing an effect size of g = 0.50 of the 27 characteristics, and 1,372 years to show an effect size of 0.24. Although several dozens of studies have compared the effects of psychotherapies in specific target groups, we will need to develop more powerful alternatives to comparative outcome studies in order to identify personalized treatments for depression.

9 Review [Internet-based approaches in prevention and treatment of depressive symptoms in adolescents and young adults ]. 2014

Berking, Matthias / Ebert, David D / Lehr, Dirk / Riper, Heleen / Sieland, Bernhard / Wiencke, Carmen. · ·Prax Kinderpsychol Kinderpsychiatr · Pubmed #24877779.

ABSTRACT: Epidemiological findings indicate that up to 18.5 % of the German adolescents suffer from depressive symptoms and that younger adults display the highest risk for relevant symptoms of depression (9.9 %) within the German adult population. Internet-based interventions have been shown to be useful for preventing and treating depression and are more easily disseminated in internet-savvy generations. Available programs are usually based on principles of cognitive behavioural therapy. They differ significantly with regard to target groups, structure, content, degree of guidance provided by online-coaches and evidence for their efficacy. Whereas some studies could not prove the use of the trainings there are others that show large effect sizes (up to d = 0.84) for the reduction of depressive symptoms. In Germany there are some online counseling programs for children and adolescents in (acute) crises available. However, at this point no structured intervention program for the treatment of depression exists.

10 Review Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. 2014

van Zoonen, Kim / Buntrock, Claudia / Ebert, David Daniel / Smit, Filip / Reynolds, Charles F / Beekman, Aartjan T F / Cuijpers, Pim. ·Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands, Leuphana University Innovation Incubator, Division Health Trainings Online, Lüneburg, Germany, Philips University, Department of Psychology, Clinical Psychology and Psychotherapy, Marburg, Germany, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands, Department of Epidemiology and Biostastics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA and Department of Psychiatry and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands. ·Int J Epidemiol · Pubmed #24760873.

ABSTRACT: BACKGROUND: Depressive disorders are highly prevalent, have a detrimental impact on the quality of life of patients and their relatives and are associated with increased mortality rates, high levels of service use and substantial economic costs. Current treatments are estimated to only reduce about one-third of the disease burden of depressive disorders. Prevention may be an alternative strategy to further reduce the disease burden of depression. METHODS: We conducted a meta-analysis of randomized controlled trials examining the effects of preventive interventions in participants with no diagnosed depression at baseline on the incidence of diagnosed depressive disorders at follow-up. We identified 32 studies that met our inclusion criteria. RESULTS: We found that the relative risk of developing a depressive disorder was incidence rate ratio = 0.79 (95% confidence interval: 0.69-0.91), indicating a 21% decrease in incidence in prevention groups in comparison with control groups. Heterogeneity was low (I(2) = 24%). The number needed to treat (NNT) to prevent one new case of depressive disorder was 20. Sensitivity analyses revealed no differences between type of prevention (e.g. selective, indicated or universal) nor between type of intervention (e.g. cognitive behavioural therapy, interpersonal psychotherapy or other). However, data on NNT did show differences. CONCLUSIONS: Prevention of depression seems feasible and may, in addition to treatment, be an effective way to delay or prevent the onset of depressive disorders. Preventing or delaying these disorders may contribute to the further reduction of the disease burden and the economic costs associated with depressive disorders.

11 Article The more I got, the less I need? Efficacy of Internet-based guided self-help compared to online psychoeducation for major depressive disorder. 2019

Reins, Jo Annika / Boß, Leif / Lehr, Dirk / Berking, Matthias / Ebert, David Daniel. ·Institute of Psychology, Leuphana University Lueneburg, Universitaetsallee 1, 21335 Lueneburg, Germany. Electronic address: reins@leuphana.de. · Institute of Psychology, Leuphana University Lueneburg, Universitaetsallee 1, 21335 Lueneburg, Germany. · Institute of Psychology, Friedrich-Alexander-University Erlangen-Nuremberg, Naegelsbachstraße 25a, 91052 Erlangen, Germany. ·J Affect Disord · Pubmed #30611913.

ABSTRACT: BACKGROUND: This study's aims were to compare the efficacy and negative effects of guided Internet-based cognitive behavior therapy (iCBT) and online psychoeducation (OPE) in people with major depression. METHODS: A total of 131 individuals were randomized. Assessments took place at baseline (T1), six weeks (T2), and three months (T3). The primary endpoint was change in observer-based depression severity from T1 to T2. Potential negative effects were analyzed in terms of suicidal ideations, symptom deterioration, attitudes toward seeking further help, and other adverse events. RESULTS: iCBT (n = 65) and OPE (n = 66) both reduced depressive symptoms from T1 to T2, with large changes observed for iCBT and medium for OPE (iCBT: Cohen's d = 1.09; OPE: d = 0.60). Differences between groups were significant at the primary endpoint (d = 0.36, p = 0.028). OPE continued to have a positive effect from post-treatment to follow-up, while the effect of iCBT remained stable, with differences between groups not being significant anymore at follow-up. Participants who had undergone prior psychotherapy benefited from both treatments; but for those without prior psychotherapy, iCBT was superior also at follow-up. In the iCBT group 26.2% of the participants reported at least one side-effect. LIMITATIONS: The history of psychotherapy was imbalanced between the groups. Some negative effects were assessed in the iCBT group only. CONCLUSIONS: Both iCBT and OPE were effective in reducing depressive symptoms, but with iCBT having a more rapid effect. iCBT was specifically superior in those with no prior history of psychotherapy. Negative effects occurred frequently and should be considered when implementing iCBT. TRIAL REGISTRATION: German clinical trials register: DRKS00005025.

12 Article Effectiveness and acceptance of a web-based depression intervention during waiting time for outpatient psychotherapy: study protocol for a randomized controlled trial. 2018

Grünzig, Sasha-Denise / Baumeister, Harald / Bengel, Jürgen / Ebert, David / Krämer, Lena. ·Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany. sashi.gruenzig@psychologie.uni-freiburg.de. · Department of Clinical Psychology and Psychotherapy, University of Ulm, Albert-Einstein-Allee 47, 89081, Ulm, Germany. · Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany. · Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Nägelsbachstr. 25a, 91052, Erlangen, Germany. ·Trials · Pubmed #29788996.

ABSTRACT: BACKGROUND: Due to limited resources, waiting periods for psychotherapy are often long and burdening for those in need of treatment and the health care system. In order to bridge the gap between initial contact and the beginning of psychotherapy, web-based interventions can be applied. The implementation of a web-based depression intervention during waiting periods has the potential to reduce depressive symptoms and enhance well-being in depressive individuals waiting for psychotherapy. METHODS: In a two-arm randomized controlled trial, effectiveness and acceptance of a guided web-based intervention for depressive individuals on a waitlist for psychotherapy are evaluated. Participants are recruited in several German outpatient clinics. All those contacting the outpatient clinics with the wish to enter psychotherapy receive study information and a depression screening. Those adults (age ≥ 18) with depressive symptoms above cut-off (CES-D scale > 22) and internet access are randomized to either intervention condition (treatment as usual and immediate access to the web-based intervention) or waiting control condition (treatment as usual and delayed access to the web-based intervention). At three points of assessment (baseline, post-treatment, 3-months-follow-up) depressive symptoms and secondary outcomes, such as quality of life, attitudes towards psychotherapy and web-based interventions and adverse events are assessed. Additionally, participants' acceptance of the web-based intervention is evaluated, using measures of intervention adherence and satisfaction. DISCUSSION: This study investigates a relevant setting for the implementation of web-based interventions, potentially improving the provision of psychological health care. The results of this study contribute to the evaluation of innovative and resource-preserving health care models for outpatient psychological treatment. TRIAL REGISTRATION: This trial has been registered on 13 February 2017 in the German clinical trials register (DRKS); registration number DRKS00010282 .

13 Article Effectiveness of a transdiagnostic individually tailored Internet-based and mobile-supported intervention for the indicated prevention of depression and anxiety (ICare Prevent) in Dutch college students: study protocol for a randomised controlled trial. 2018

Bolinski, Felix / Kleiboer, Annet / Karyotaki, Eirini / Bosmans, Judith E / Zarski, Anna-Carlotta / Weisel, Kiona K / Ebert, David D / Jacobi, Corinna / Cuijpers, Pim / Riper, Heleen. ·Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, BT 1081, Amsterdam, The Netherlands. f.bolinski@vu.nl. · Amsterdam Public Health research institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. f.bolinski@vu.nl. · Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, BT 1081, Amsterdam, The Netherlands. · Amsterdam Public Health research institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. · Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. · Department of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany. ·Trials · Pubmed #29458407.

ABSTRACT: BACKGROUND: Depression and anxiety are common and co-morbid disorders that affect a significant proportion of students. Innovative prevention strategies targeting both conditions are needed to reduce their health burden and costs. ICare Prevent is such an innovative strategy and contains a transdiagnostic individually tailored Internet-based and mobile-supported intervention. It addresses common risk factors of depression and anxiety as part of a large EU-funded multi-country project* (ICare). Little is known about the clinical and cost-effectiveness of this type of intervention compared to care as usual (CAU) for college students. We hypothesize that ICare Prevent will be more (cost-)effective than CAU in the reduction of symptoms of depression and anxiety. METHODS: A three-arm, parallel, randomized controlled superiority trial will be conducted comparing a guided and an unguided version of ICare Prevent with a control group receiving CAU. The trial will be open-label but outcome assessors will be blinded. A total of 252 college students (age ≥ 16 years) with subclinical symptoms of depression defined as a score ≥ 16 on the Center for Epidemiological Studies Depression Scale (CES-D), and/or anxiety, defined as a score ≥ 5 on the Generalized Anxiety Disorder scale (GAD-7), will be included. Those meeting diagnostic criteria for a depressive or anxiety disorder will be excluded. The primary outcome is change in disorder specific symptom severity from baseline to post-intervention. Secondary endpoints include self-reported depression and anxiety symptoms as well as time to onset of a mood or anxiety disorder until 12-month follow-up. Societal costs and quality of life will be assessed to estimate the intervention's cost-effectiveness compared to CAU. DISCUSSION: Transdiagnostic individually tailored Internet-based prevention could be a (cost-)effective approach to tackle the disease burden of depression and anxiety among college students. TRIAL REGISTRATION: Dutch trial register, NTR 6562 . Registered on 6 July 2017.

14 Article Effectiveness of Web- and Mobile-Based Treatment of Subthreshold Depression With Adherence-Focused Guidance: A Single-Blind Randomized Controlled Trial. 2018

Ebert, David Daniel / Buntrock, Claudia / Lehr, Dirk / Smit, Filip / Riper, Heleen / Baumeister, Harald / Cuijpers, Pim / Berking, Matthias. ·Friedrich-Alexander University Erlangen-Nuremberg; Leuphana University Lueneburg. Electronic address: david.ebert@fau.de. · Friedrich-Alexander University Erlangen-Nuremberg; Leuphana University Lueneburg; VU University Amsterdam. · Leuphana University Lueneburg. · VU University Amsterdam; Trimbos Institute. · Leuphana University Lueneburg; VU University Amsterdam; University of Southern Denmark. · University of Ulm. · Leuphana University Lueneburg; VU University Amsterdam. · Friedrich-Alexander University Erlangen-Nuremberg; Leuphana University Lueneburg. ·Behav Ther · Pubmed #29405923.

ABSTRACT: Evidence for the impact of psychological Interventions for subthreshold depression (sD) is conflicting. Moreover, human resources to deliver such treatments are limited. This study aimed to evaluate the effectiveness of a web-based intervention with adherence-focused guidance in the treatment of sD. Participants with sD (CES-D≥ 16, no Major Depressive Disorder according to DSM-IV criteria, N = 204) recruited via a large health insurance were randomly allocated to a web-based mobile-supported cognitive-behavioral intervention or to a waitlist control condition with unrestricted access to usual care. The primary outcome was the reduction in depressive symptom severity as measured by blind diagnostic raters using the Quick Inventory of Depressive Symptomatology (QIDS) at posttreatment. There was a statistically significant between-group difference in QIDS scores at posttreatment in favor of the intervention group, F(1, 201) = 11.31, p = .001, corresponding to a medium effect size of d = 0.37 (95% CI 0.09-0.64) and a NNT of 7 (95%-CI 3.7-41.2). Significant effects in favour of the intervention group were also found for secondary outcomes such as quality of life, anxiety, and insomnia severity. Web-based self-help interventions with adherence-focused guidance could be an acceptable and effective approach to reduce a range of negative consequences associated with subclinical depression.

15 Article Problem-solving therapy for adult depression: An updated meta-analysis. 2018

Cuijpers, Pim / de Wit, Leonore / Kleiboer, Annet / Karyotaki, Eirini / Ebert, David D. ·Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands. Electronic address: p.cuijpers@vu.nl. · Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands. · Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. ·Eur Psychiatry · Pubmed #29331596.

ABSTRACT: BACKGROUND: Problem-solving therapy (PST) is one of the best examined types of psychotherapy for adult depression. No recent meta-analysis has examined the effects of PST compared to control groups or to other treatments. We wanted to verify whether PST is effective, whether effects are comparable to those of other treatments, and whether we could identify the possible sources of high heterogeneity that was found in earlier meta-analyses. METHODS: We conducted systematic searches in bibliographical databases, including PubMed, PsycInfo, Embase and the Cochrane database of randomized trials. RESULTS: We included 30 randomized controlled trials on PST (with 3530 patients), in which PST was compared to control conditions, with other therapies, and with pharmacotherapy. We could compare these 30 trials on PST also with 259 trials on other psychotherapies for adult depression. The effect size of PST versus control groups was g=0.79 (0.57-1.01) with very high heterogeneity (I CONCLUSION: PST is probably an effective treatment for depression, with effect sizes that are small, but comparable to those found for other psychological treatments of depression.

16 Article Turning Good Intentions Into Actions by Using the Health Action Process Approach to Predict Adherence to Internet-Based Depression Prevention: Secondary Analysis of a Randomized Controlled Trial. 2018

Zarski, Anna-Carlotta / Berking, Matthias / Reis, Dorota / Lehr, Dirk / Buntrock, Claudia / Schwarzer, Ralf / Ebert, David Daniel. ·Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. · Leuphana University Lüneburg, Lüneburg, Germany. · University Koblenz-Landau, Landau, Germany. · SWPS University of Social Sciences and Humanities, Warszawa, Poland. ·J Med Internet Res · Pubmed #29326097.

ABSTRACT: BACKGROUND: Many individuals engaging in Internet-based interventions fail to complete these treatments as intended. The processes responsible for treatment adherence in Internet-based interventions are still poorly understood. OBJECTIVE: The aim of this study was to investigate to what extent adherence in an Internet-based intervention can be predicted by motivational and volitional factors outlined in the health action process approach (HAPA). METHODS: This study investigated motivational and volitional factors included in HAPA in a randomized controlled trial to predict treatment adherence of N=101 individuals with subclinical depression in the intervention group of a depression prevention intervention (GET.ON Mood Enhancer). Adherence was operationalized as the number of completed treatment modules. Using longitudinal structural equation modeling, HAPA variables (motivational, maintenance, and recovery self-efficacy, outcome expectancies, intention, and planning) were assessed at baseline and their associations with adherence 7 weeks later. RESULTS: Planning predicted adherence. Better planning was, in turn, associated with higher levels of maintenance self-efficacy, and the latter significantly affected treatment adherence via planning. The other hypothesized direct associations were not significant. In total, the HAPA variables accounted for 14% of variance in treatment adherence. CONCLUSIONS: Planning emerged as the strongest predictor of treatment adherence in highly motivated participants in an Internet-based intervention out of all HAPA variables investigated. Findings are in line with the hypothesis that planning facilitates the translation of good intentions into actions. The findings imply that systematically fostering planning skills and maintenance self-efficacy prior to or during Internet-based interventions would help participants to successfully complete these treatments. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005973; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00005973 (Archived by WebCite at http://www.webcitation.org/6uxCy64sy).

17 Article Evaluation of a text-message-based maintenance intervention for Major Depressive Disorder after inpatient cognitive behavioral therapy. 2018

Schlicker, Sandra / Ebert, David D / Middendorf, Thomas / Titzler, Ingrid / Berking, Matthias. ·Friedrich-Alexander University Erlangen-Nuernberg, Germany; Philipps-University Marburg, Germany. Electronic address: Sandra.Schlicker@fau.de. · Friedrich-Alexander University Erlangen-Nuernberg, Germany. · Schön Klinik Bad Arolsen, Psychosomatic Hospital, Germany. ·J Affect Disord · Pubmed #29132073.

ABSTRACT: INTRODUCTION: High relapse rates in Major Depressive Disorder (MDD) indicate the need for interventions enhancing the sustainability of treatment outcomes. Primary aim of the present study was to evaluate the effectiveness of a text-message-based maintenance intervention for depression (TMMI-D). Additionally, we aimed to clarify whether the use of individualized messages would lead to better outcome than the use of standardized messages which focused upon adaptive ways of regulating undesired emotions. METHODS: In this RCT, 226 individuals who had completed inpatient treatment for MDD were randomly allocated to a condition in which participants received TMMI-D with standardized messages targeting emotion regulation, or to a condition with individualized messages, or to a waitlist control condition. Primary outcome was depressive symptom severity assessed with the BDI-II. RESULTS: Multilevel analyses suggest that participants receiving TIMMI-D with standardized messages reported a significantly smaller increase of depressive symptoms during the post-treatment and follow-up interval than did patients in the waitlist control condition. Contrastingly, there was no such effect for patients who had used TIMMI-D with individualized messages. LIMITATIONS: Limitations include proportions of missing data, thus, generalizing the findings of the present study might be an overestimation. CONCLUSION: Text-message-based interventions may help increase the sustainability of outcome after treatment for MDD. The unexpected superiority of the standardized over the individualized version is in line with research that points to the efficacy of interventions fostering adaptive emotion regulation as a means to treat depression (and other mental disorders).

18 Article 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. 2017

Lin, Jiaxi / Sander, Lasse / Paganini, Sarah / Schlicker, Sandra / Ebert, David / Berking, Matthias / Bengel, Jürgen / Nobis, Stephanie / Lehr, Dirk / Mittag, Oskar / Riper, Heleen / Baumeister, Harald. ·Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany. · Psychology Department, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, United Kingdom. · Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Erlangen, Germany. · Department of Gerontology, University of Vechta, Vechta, Germany. · Department of Psychology, Leuphana University Lüneburg, Lüneburg, Germany. · Section of Health Care Research and Rehabilitation, Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Freiburg, Germany. · Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands. · Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Ulm, Ulm, Germany. ·BMJ Open · Pubmed #29288172.

ABSTRACT: 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.

19 Article An Internet-Based Intervention for Chronic Pain. 2017

Lin, Jiaxi / Paganini, Sarah / Sander, Lasse / Lüking, Marianne / Ebert, David Daniel / Buhrman, Monica / Andersson, Gerhard / Baumeister, Harald. ·Department of Rehabilitational Psychology and Psychotherapy, Institute of Psychology, University of Freiburg; Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Private Practice, Freiburg; Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg; Department of Psychology, Uppsala University, Sweden; Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education Science, University of Ulm. ·Dtsch Arztebl Int · Pubmed #29082858.

ABSTRACT: BACKGROUND: Persons with chronic pain can be treated effectively with acceptance and commitment therapy (ACT). In this trial, we examined the effectiveness of guided and unguided ACT-based online treatment (ACTonPain) for chronic pain patients. METHODS: 302 individuals were randomly assigned to ACTonPain with or without guidance (n = 100/101) or to a waiting-list control group (n=101). The primary outcome was pain interference as measured by the Multidimensional Pain Inventory. The secondary outcomes were physical and emotional functioning, pain intensity, ACT process variables, quality of life, satisfaction with the intervention, adherence, and participants' rating of overall improvement. The online measurements were carried out before randomization (T0) and 9 weeks and 6 months after randomization (T1 and T2, respectively). Intention-to-treat (ITT) data analysis was supplemented with additional per-protocol analyses. RESULTS: The guided ACTonPain group showed significantly less pain interference than the control group in the ITT analysis (p = 0.01), with a moderate effect size at T1 and T2 (d = 0.58 respectively), corresponding to a number needed to treat (NNT) of 3.14 for both time points. Participants in the guided ACTonPain group also indicated higher pain acceptance (T1: d = 0.59; T2: d = 0.76). The unguided ACTonPain group showed to be significantly less depressed in comparison to the control group at at time T2 (d = 0.50). No significant differences with respect to effectiveness were found between the two ACTonPain groups (p>0.05). CONCLUSION: The online intervention ACTonPain is effective for persons with chronic pain when the program is guided. Further research in a variety of settings of health care is needed in order to determine whether and how ACTonPain can be implemented.

20 Article Emotion Regulation Protects Against Recurrence of Depressive Symptoms Following Inpatient Care for Major Depressive Disorder. 2017

Ebert, David D / Hopfinger, Lisa / Bockting, Claudi L H / Berking, Matthias. ·Friedrich-Alexander-University Erlangen-Nuremberg. · Philipps-University Marburg. · University of Utrecht. ·Behav Ther · Pubmed #29029672.

ABSTRACT: Relapse following response in psychotherapy for major depressive disorder (MDD) is a major concern. Emotion regulation (ER) has been discussed as a putative emerging and maintaining factor for depression. The purpose of the present study was to examine whether ER protects against recurrence of depression over and above residual symptoms of depression following inpatient care for MDD. ER skills (ERSQ-ES) and depression (HEALTH-49) were assessed in 193 patients with MDD (age, M = 47.4, SD = 9.6, 75.1% female, 100% Caucasian) at treatment discontinuation, 3 and 12 months after treatment. Multiple hierarchical regressions were used to examine general and specific ER as predictors of depressive symptoms at follow-ups. Higher general ER predicted lower depression over and beyond residual symptoms of depression at 3-month follow-up among treatment responders but not among treatment nonresponders. With regard to specific ER skills, readiness to confront and acceptance of undesired emotions predicted lower depressive symptoms beyond residual symptoms of depression 12 months, respectively 3 and 12 months after treatment. Findings of the present study indicate that targeting general ER might be more important for remitted and less important for nonremitted patients. Enhancing ER should hence be realized in a sequential treatment design, in which a continuation phase treatment with a specific focus on ER directly follows, once patients sufficiently responded to treatment. Acceptance of undesired emotion and readiness to confront situations that cue these emotions appear to be particularly important for protecting against recurrence of depression. Future research should clarify whether findings can be generalized to outpatient care.

21 Article Internet-Based Self-help Interventions for Depression in Routine Care. 2017

Ebert, David Daniel / Baumeister, Harald. ·Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany. · Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany. ·JAMA Psychiatry · Pubmed #28636717.

ABSTRACT: -- No abstract --

22 Article Effectiveness and cost-effectiveness of a guided Internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain-study protocol of the PROD-BP multicenter pragmatic RCT. 2017

Sander, L / Paganini, S / Lin, J / Schlicker, S / Ebert, D D / Buntrock, C / Baumeister, H. ·Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany. lasse.sander@psychologie.uni-freiburg.de. · Medical Faculty, Medical Psychology and Medical Sociology, University of Freiburg, Hebelstraße 29, Freiburg, 79104, Germany. lasse.sander@psychologie.uni-freiburg.de. · Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany. · Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nürnberg, Nägelsbachstr. 25a, D- 91052, Erlangen, Germany. · Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, University of Ulm, Albert-Einstein-Allee 47, D-89069, Ulm, Germany. ·BMC Psychiatry · Pubmed #28109247.

ABSTRACT: BACKGROUND: Reducing the disease burden of major depressive disorder (MDD) is of major public health relevance. The prevention of depression is regarded as one possible approach to reach this goal. People with multiple risk factors for MDD such as chronic back pain and subthreshold depressive symptoms may benefit most from preventive measures. The Internet as intervention setting allows for scaling up preventive interventions on a public mental health level. METHODS: This study is a multicenter pragmatic randomized controlled trial (RCT) of parallel design aiming to investigate the (cost-) effectiveness of an Internet- and mobile-based intervention (IMI) for the prevention of depression in chronic back pain patients (PROD-BP) with subthreshold depressive symptoms. eSano BackCare-DP is a guided, chronic back pain-specific depression prevention intervention based on cognitive behavioral therapy (CBT) principles comprising six weekly plus three optional modules and two booster sessions after completion of the intervention. Trained psychologists provide guidance by sending feedback messages after each module. A total of 406 patients with chronic back pain and without a depressive disorder at baseline will be recruited following orthopedic rehabilitation care and allocated to either intervention or treatment-as-usual (TAU). Primary patient-relevant endpoint of the trial is the time to onset of MDD measured by the telephone-administered Structured Clinical Interview for DSM (SCID) at baseline and 1-year post-randomization. Key secondary outcomes are health-related quality of life, depression severity, pain intensity, pain-related disability, ability to work, intervention satisfaction and adherence as well as side effects of the intervention. Online assessments take place at baseline and 9 weeks as well as 6 and 12 months post-randomization. Cox regression survival analysis will be conducted to estimate hazard ratio at 12-month follow-up. Moreover, an economic analysis will be conducted from a societal and public health perspective. DISCUSSION: This is the first study examining an IMI for depression prevention in a sample of chronic pain patients. If this implementation of a depression prevention IMI into orthopedic aftercare proves effective, the intervention could be integrated into routine care with minimal costs and extended for use with other chronic diseases. Results will have implications for researchers, health care providers and public health policy makers. TRIAL REGISTRATION: The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS): DRKS00007960 . Registered 12 August 2015.

23 Article Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention. 2017

Buntrock, Claudia / Berking, Matthias / Smit, Filip / Lehr, Dirk / Nobis, Stephanie / Riper, Heleen / Cuijpers, Pim / Ebert, David. ·Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany. · EMGO+ Institute for Health and Care Research, Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands. · Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. · Trimbos Institute, Centre of Health-Economic Evaluation, Utrecht, Netherlands. · EMGO+ Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands. · Department for Gerontology, University of Vechta, Vechta, Germany. · Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark. ·J Med Internet Res · Pubmed #28052841.

ABSTRACT: BACKGROUND: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. OBJECTIVE: To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD). METHODS: A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). RESULTS: In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention's likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY. CONCLUSIONS: Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9).

24 Article The 6-month effectiveness of Internet-based guided self-help for depression in adults with Type 1 and 2 diabetes mellitus. 2017

Ebert, D D / Nobis, S / Lehr, D / Baumeister, H / Riper, H / Auerbach, R P / Snoek, F / Cuijpers, P / Berking, M. ·Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. · Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany. · Department for Health Care Policy, Harvard University, Boston, MA, USA. · Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany. · Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. · Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA. · Department of Medical Psychology, VU University Medical Centre and Academic Medical Center, Amsterdam, The Netherlands. · Institute for Health and Care Research (EMGO), VU University Medical Centre, Amsterdam, The Netherlands. ·Diabet Med · Pubmed #27334444.

ABSTRACT: AIM: The aim of this research is to examine the 6-month effects of an Internet-based guided self-help intervention for comorbid depressive symptoms in people with diabetes. METHODS: Participants (n = 260) with Type 1 or 2 diabetes and elevated depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) ≥ 23] were randomly assigned to a guided Internet-based self-help intervention or a control condition (treatment as usual + online psychoeducation about depression). The primary outcome was a change in depressive symptom severity (CES-D) from baseline to 6-month follow-up. The secondary outcomes included numbers of people achieving treatment response (reliable change of depressive symptoms) and remission (CES-D ≤ 16), as well as the effects on glycaemic control, diabetes-related emotional distress and diabetes acceptance. Repeated measures analysis of variance examined between-group differences using intent-to-treat principles. RESULTS: Both conditions showed improvements in depression severity: intervention condition, d = 1.48 [95% confidence interval (95% CI): 1.21 to 1.76]; control condition d = 0.55 (95% CI: 0.30 to 0.80). Changes were significantly greater in the intervention condition with a large between-group effect size (d = 0.83, 95% CI: 0.57 to 1.08). Accordingly, effects on response [relative risk (RR) = 2.60 (95% CI: 2.01 to 3.36), P < 0.001] and remission [RR = 3.36 (95% CI: 2.98 to 5.44), P < 0.001] were in favour of the intervention group, as were differences in change in diabetes emotional distress (d = 0.50, 95% CI: 0.04 to 0.54), and physical and mental functioning [Short Form Health Survey (SF-12) Physical d = 0.27 (95% CI: 0.01 to 0.51) and SF-12 Mental d = 0.68 (95% CI: 0.11 to 0.40)]. The intervention group was not superior with regard to glycaemic control, diabetes self-management and diabetes acceptance. CONCLUSIONS: The trial indicates that Internet-based guided self-help treatments for depression in people with diabetes can have sustained effects on depressive symptoms, well-being and emotional distress associated with diabetes.

25 Article Reactivity to smartphone-based ecological momentary assessment of depressive symptoms (MoodMonitor): protocol of a randomised controlled trial. 2016

van Ballegooijen, Wouter / Ruwaard, Jeroen / Karyotaki, Eirini / Ebert, David D / Smit, Johannes H / Riper, Heleen. ·Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands. w.van.ballegooijen@vu.nl. · Department of Psychiatry, VU Medical Centre/GGZ inGeest, Amsterdam, Netherlands. w.van.ballegooijen@vu.nl. · Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands. · Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. · Department of Psychiatry, VU Medical Centre/GGZ inGeest, Amsterdam, Netherlands. ·BMC Psychiatry · Pubmed #27769201.

ABSTRACT: BACKGROUND: Ecological momentary assessment (EMA) of mental health symptoms may influence the symptoms that it measures, i.e. assessment reactivity. In the field of depression, EMA reactivity has received little attention. We aim to investigate whether EMA of depressive symptoms induces assessment reactivity. Reactivity will be operationalised as an effect of EMA on depressive symptoms measured by a retrospective questionnaire, and, secondly, as a change in response rate and variance of the EMA ratings. METHODS: This study is a 12-week randomised controlled trial comprising three groups: group 1 carries out EMA of mood and completes a retrospective questionnaire, group 2 carries out EMA of how energetic they feel and completes a retrospective questionnaire, group 3 is the control group, which completes only the retrospective questionnaire. The retrospective questionnaire (Centre for Epidemiologic Studies Depression scale; CES-D) assesses depressive symptoms and is administered at baseline, 6 weeks after baseline and 12 weeks after baseline. We aim to recruit 160 participants who experience mild to moderate depressive symptoms, defined as a Patient Health Questionnaire (PHQ-9) score of 5 to 15. This study is powered to detect a small between-groups effect, where no clinically relevant effect is defined as the effect size margin -0.25< d <0.25. DISCUSSION: To our knowledge, this is the first study to investigate whether self-rated EMA of depressive symptoms could induce assessment reactivity among mildly depressed individuals. TRIAL REGISTRATION: Netherlands Trial Register NTR5803. Registered 12 April 2016. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5803 .

Next