In a recent article in the Journal of Telemedicine and Telecare, researchers sought to better quantify the potential benefits of using web-based interventions to manage and treat depression in patients with other chronic diseases.
The association of depression with a variety of chronic diseases is well recognized. For example, patients with heart failure are known to have a high prevalence of depression that can be particularly difficult to treat. While there are a number of resources out there, the quality is varied and effectiveness is uncertain.
In this study, researchers systematically reviewed all articles written in English from 1990 to 2014 that targeted adult participants (18 and older) with a primary diagnosis of a chronic illness and comorbid depression. Depression was defined based on DSM-III-R or later criteria or depressive symptomatology with a certain cutoff level based on self-report or clinician report in a given study. The researchers also had clear criteria for web-based interventions being reviewed, specifying that they target depressive symptomatology with the specific intent to produce emotional, behavioral and cognitive change.
A total of 10,190 studies were identified. The vast majority of these articles were screened out based on researchers’ criteria, with 11 articles remaining for the review. The quality of studies was determined using a 27 item Quality Index by Downs and Black – a checklist for effectively assessing the methodology quality of randomized controlled trials and nonrandomized studies. Quality scores for the studies ranged from 14 to 19 out of a maximum of 32. The researchers indicated that most of the studies were “statistically underpowered although internal validity was demonstrated.”
The effect size of the studies was estimated using Cohen’s d effect sizes – a method for determining the effect size of a difference between two means. There were a total of 1,348 research participants in all the studies combined. The most common comorbidities were diabetes and multiple sclerosis.
The effect sizes of the studies indicated that there were significant short term improvements in depression severity (d w=0.36, CI=0.20-0.52, p<0.01), along with “quality of life, problem-solving skills, functional ability, anxiety and pain-related cognitions (d range=0.23 to 1.10). They however also noted that data on long term impacts was limited.
For many chronic medical conditions, comorbid mood disorders are common and often compound the severity of the symptoms associated with those conditions. And as more and more patients are affected by multiple chronic medical conditions, recognizing and treating these mood disorders is going to be critical to improving our patients’ quality of life.
Especially given the limited availability of mental health services, web and mobile interventions can offer a scalable and accessible tool to manage comorbid mood disorders. This meta-analysis as well as other studies are promising in terms of effectiveness but also remind us that more ongoing research is needed to understand which tools are more effective and how best they can be utilized.