Background: Comorbid depression and diabetes (DM) are associated with poorer quality of life, poorer self-management and glycemic control, higher health service utilization, increased risk for DM complications and higher mortality rates. Depression remains under-recognized and undertreated in people with DM, which may, in part, result from barriers associated with accessing face-to-face treatment. Cost—effective and accessible forms of depression treatment need to be developed and evaluated.
Objective: To examine the efficacy of a 6-lesson internet-based Cognitive Behavioural Therapy program for Major Depressive Disorder (iCBT-MDD) in people with Diabetes Mellitus (DM).
Research Design and Methods: Participants with comorbid MDD and DM (Type 1 or 2) were randomly allocated to the intervention (iCBT-MDD) versus a treatment as usual control group who received the iCBT-MDD program after 10 weeks. Primary outcomes were self-reported depression (PHQ-9), DM-related distress (PAID) and self-reported glycaemic control (HbA1c). Secondary outcomes were general distress (K10) and disability (SF-12), generalised anxiety (GAD-7), somatisation, eating habits, alcohol use (PHQ modules), and lifestyle behaviours. The iCBT group was also assessed at 3-months to explore outcomes.
Results: Participants in the iCBT condition showed significant reductions between baseline and post-treatment in the primary measures of depression (PHQ9; Cohen’s d=1.68, 95%CIs = 1.19-2.17) and PAID (Cohen’s d=1.63, 95%CIs=0.09-1.26). Analyses indicated between-group superiority of iCBT over TAU on the primary and secondary outcome measures at post (Hedges g’s =.75-1.01, 95%CIs=.23-1.54). Gains were maintained at follow-up; evidence of relapse in the iCBT group will be discussed. Clinically significant change following iCBT on PHQ-9 scores was 47% vs. 12% in TAU. The majority of iCBT participants (84%) no longer met diagnostic criteria for depression at 3-month follow-up.
Conclusions: iCBT for depression is an efficacious, low-cost, accessible treatment option for people with diabetes. Future studies should explore whether tailoring of iCBT programs improves acceptability and adherence, and evaluate the long-term outcomes.