Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 19, 2018
Open Peer Review Period: Sep 22, 2018 - Nov 17, 2018
Date Accepted: Dec 12, 2018
(closed for review but you can still tweet)
A web-based public health intervention to reduce functional impairment and depressive symptoms in adults with type 2 diabetes (the SpringboarD Trial): Results of a randomised controlled trial.
ABSTRACT
Background:
Depressive symptoms are common in people with type 2 diabetes and exacerbate disease burden through increased social and occupational impairment and greater morbidity and mortality. Effective depression treatments exist, however rates of depression screening in type 2 diabetes are variable, access to psychological support is characteristically low, and impact of treatment on daily functioning remains unclear. Web-based cognitive behaviour therapy (CBT) is easily accessible, private, non-stigmatising and a potential solution to reducing the substantial personal and public health impact of comorbid type 2 diabetes and depression.
Objective:
To evaluate the efficacy of the web-based CBT program, myCompass, for improving social and occupational functioning in a large community sample of people with type 2 diabetes and self-reported mild-to-moderate depressive symptoms. myCompass is an unguided, public health treatment program for common mental health problems. Impact of treatment on depressive symptoms, diabetes-related distress, anxiety symptoms and self-care behaviour was also examined.
Methods:
Participants with type 2 diabetes and mild-to-moderate depressive symptoms (N = 780) were recruited online and via community and general practice settings. Screening, consent and data collection were conducted online, and randomisation was to either myCompass (n = 391) for 8 weeks plus a 4-week tailing off period, or an active placebo intervention (n = 379). At baseline and post-intervention (3-months), participants completed the Work and Social Adjustment Scale (WSAS), the primary outcome measure. Secondary outcome measures included the Patient Health Questionnaire-9 item (PHQ-9), Diabetes Distress Scale (DDS), Generalised Anxiety Disorder Questionnaire-7 item (GAD-7) and items from the Self-Management Profile for Type 2 Diabetes (SMP-T2D).
Results:
At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite a varied and extensive recruitment process. Of the 780 trial participants, 473 (61%) completed the post-intervention assessment. Intention-to-treat analyses revealed improvement in functioning, depression, anxiety, diabetes distress and healthy eating over time in both groups. Except for blood glucose monitoring and medication adherence, there were no specific between-group effects. Follow-up analyses suggested the outcomes did not depend on age, morbidity or treatment engagement.
Conclusions:
Improvement in social and occupational functioning and the secondary outcomes was generally no greater for myCompass users than users of the control program at 3 months post-intervention. These findings should be interpreted in light of near-normal mean baseline scores on several variables, the self-selected study sample and sample attrition. Further attention to factors influencing uptake and engagement with mental health treatments by people with type 2 diabetes, and the impact of illness comorbidity on patient conceptualisation and experience of mental health symptoms, is essential to reduce the burden of type 2 diabetes. Clinical Trial: ACTRN12615000931572
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.