Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

Area of Science:

• Psychiatry and Mental Health
• Digital Health Interventions
• Clinical Psychology

Background:

• Recurrent major depression significantly impacts patients' quality of life.
• Developing strategies to prolong symptom-free intervals is crucial for managing chronic depression.
• Internet-delivered interventions offer scalable solutions for mental health support.

Purpose of the Study:

• To evaluate the efficacy of two internet-delivered augmentation strategies (SUMMIT and SUMMIT-PERSON) in prolonging symptom-free intervals for patients with recurrent major depression.
• To compare the effectiveness of these interventions against treatment as usual (TAU).

Main Methods:

• A 3-arm, multicenter, randomized controlled trial involving 232 adults with recurrent major depression.
• Participants received either SUMMIT, SUMMIT-PERSON, or TAU post-inpatient care.
• Interventions involved intense e-mail/smartphone monitoring and crisis support over 12 months; SUMMIT-PERSON included expert chats.
• The primary outcome was 'well weeks' over 24 months, assessed using the Longitudinal Interval Follow-Up Evaluation.

Main Results:

• The SUMMIT intervention significantly reduced time spent in an unwell state compared to TAU.
• SUMMIT facilitated faster transitions from unwell to well states.
• SUMMIT-PERSON did not demonstrate superiority over SUMMIT or TAU.
• The efficacy of SUMMIT was most pronounced at 8 months post-intervention.

Conclusions:

• The automated internet-delivered SUMMIT strategy can enhance treatment as usual for recurrent depression.
• SUMMIT has the potential to alleviate the lifelong burden associated with recurrent depression.
• The waning effects suggest the need for extended or continuous application of the intervention.