Reducing the incidence of depression for patients with back pain and subclinical depression using an internet- and mobile-based intervention– Follow-up assessment of a pragmatic randomized controlled large-scale trial
Final Report Abstract
Patients with persistent back pain frequently suffer from comorbid depressive symptoms, associated with negative consequences for the patient and the society. Proactively preventing depressive symptoms, rather than reacting to an existing depression, may be a promising way to reduce the disease burden. Due to the ubiquity of the Internet, particularly Internet- and mobile-based prevention (IMI) programs could be a way to achieve this. The aim of this work was to evaluate the effectiveness of the IMI Esano BackCare-DP to reduce the incidence of major depressive episode (MDE) in patients with persistent back pain. Patients with a diagnosis of persistent back pain and subclinical depressive symptoms (i.e. without diagnosed depression) were eligible for the prevention program “Prevention of Depression in Back Pain Patients” (PROD-BP). Participants were recruited either on-site or after discharge from 82 orthopedic clinics across Germany and randomized to either intervention or control group. The intervention group received the prevention program which is based on cognitive behavior therapy and adapted specifically to the needs of back pain patients. The program consists of 6 mandatory and 3 optional modules and was accompanied in the present trial by trained psychologists (e-coaches) who provided online feedback on the patient’s entries. The control group did not receive access to the program. Both the intervention and control group had unrestricted access to other treatment options. The time to onset of MDE over a 12-month period was examined. Diagnoses were made by trained psychologists who were not informed about the group membership of the patients. Furthermore, depression severity, quality of life, pain intensity, pain-related disability, pain selfefficacy, work ability, and participant satisfaction were assessed using a variety of instruments. Health-economic evaluations were also conducted. A total of 295 participants (mean age 52.8 years; 184 women [62.4%]) were recruited and randomly assigned to either the intervention group (n = 149) or the control group (n = 146). The intervention reduced the risk of MDE occurrence by 52%. 21 participants (14.1%) in the intervention group and 41 participants (28.1%) in the control group experienced MDE over the 12-month period. The number of treatments needed to prevent 1 new case of MDE was 2.84. Satisfaction with the prevention program was good. The intervention showed high potential for cost-effectiveness. The results of this study showed that depression can be prevented in patients with persistent back pain by a guided Web-based self-help intervention in addition to usual care. The effectiveness and cost-effectiveness findings suggest that the use of a scalable digital approach to integrate psychological treatment into routine pain treatment is feasible.
Publications
- Effectiveness of a Guided Web-Based Self-help Intervention to Prevent Depression in Patients With Persistent Back Pain: The PROD-BP Randomized Clinical Trial. JAMA Psychiatry 2020
Sander L, Paganini S, Terhorst Y, Schlicker S, Lin J, Spanhel K, Buntrock C, Ebert DD, Baumeister H
(See online at https://doi.org/10.1001/jamapsychiatry.2020.1021)
