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Randomized Controlled Trial
. 2023 Jul;53(9):3932-3942.
doi: 10.1017/S0033291722000599. Epub 2022 Apr 7.

Efficacy of an internet-based cognitive behavioral therapy for subthreshold depression among Chinese adults: a randomized controlled trial

Yuchen Ying  1   2 , Yunxin Ji  1 , Fanqian Kong  3 , Minyao Wang  4 , Qiqi Chen  2 , Li Wang  2 , Yanbin Hou  1 , Libo Yu  2 , Lijie Zhu  5 , Pingping Miao  1 , Jing Zhou  2 , Li Zhang  2 , Yiling Yang  2 , Guanjun Wang  1 , Ruijia Chen  2 , Denong Liu  4 , Wenjun Huang  2 , Yueer Lv  2 , Zhongze Lou  1   6 , Liemin Ruan  1
Affiliations
Randomized Controlled Trial

Efficacy of an internet-based cognitive behavioral therapy for subthreshold depression among Chinese adults: a randomized controlled trial

Yuchen Ying et al. Psychol Med. 2023 Jul.

Abstract

Background: Subthreshold depression (sD) negatively impacts well-being and psychosocial function and is more prevalent compared with major depressive disorder (MDD). However, as adults with sD are less likely to seek face-to-face intervention, internet-based cognitive-behavioral therapy (ICBT) may overcome barriers of accessibility to psychotherapy. Although several trials explored the efficacy of ICBT for sD, the results remain inconsistent. This study evaluated whether ICBT is effective in reducing depressive symptoms among Chinese adults with sD.

Methods: A randomized controlled trial was performed. The participants were randomly assigned to 5 weeks of ICBT, group-based face-to-face cognitive-behavioral therapy (CBT), or a waiting list (WL). Assessments were conducted at baseline, post-intervention and at a 6-month follow-up. The primary outcome measured depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D). Outcomes were analyzed using a mixed-effects model to assess the effects of ICBT.

Results: ICBT participants reported greater reductions on all the outcomes compared to the WL group at post-intervention. The ICBT group showed larger improvement on the Patient Health Questionnaire-9 (PHQ-9) at post-intervention (d = 0.12) and at follow-up (d = 0.10), and with CES-D at post-intervention (d = 0.06), compared to the CBT group.

Conclusions: ICBT is effective in reducing depressive symptoms among Chinese adults with sD, and improvements in outcomes were sustained at a 6-month follow-up. Considering the low rates of face-to-face psychotherapy, our findings highlight the considerable potential and implications for the Chinese government to promote the use of ICBT for sD in China.

Keywords: Chinese populations; internet-based cognitive-behavioral therapy; randomized controlled trial; subthreshold depression.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
Flowchart of participants.
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References

    1. Andersson, G., Bergstrm, J., Hollndare, F., Ekselius, L., & Carlbring, P. (2004). Delivering cognitive behavioural therapy for mild to moderate depression via the internet: Predicting outcome at 6-month follow-up. Verhaltenstherapie, 14, 185–189. doi:10.1159/000080914 - DOI
    1. Andersson, G., Hesser, H., Veilord, A., Svedling, L., Andersson, F., Sleman, O., & …Carlbring, P. (2013). Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression. Journal of Affective Disorders, 151(3), 986–994. doi:10.1016/j.jad.2013.08.022 - DOI - PubMed
    1. Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P. (2019). Internet-delivered psychological treatments: From innovation to implementation. World Psychiatry, 18(1), 20–28. doi:10.1002/wps.20610 - DOI - PMC - PubMed
    1. Andersson, G., Topooco, N., Havik, O., & Nordgreen, T. (2016). Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Review of Neurotherapeutics, 16(1), 55–60. doi:10.1586/14737175.2015.1125783 - DOI - PubMed
    1. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation.

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