OBJECTIVE—Comorbid depression is common in patients with type 1 and type 2 diabetes, adversely affecting quality of life, diabetes outcomes, and mortality. Depression can be effectively treated with cognitive behavior therapy (CBT). The Internet is a new and attractive method for delivering CBT intervention on a large scale at relatively low costs. This study evaluated the effectiveness ofWeb-based CBT for depression treatment in adults with type 1 or type 2 diabetes, with minimal guidance.
RESEARCH DESIGN ANDMETHODS—A randomized controlled trial was conducted in the Netherlands in 255 adult diabetic patients with elevated depressive symptoms. Primary outcomes were depressive symptoms. Secondary outcomes were diabetes-specific emotional distress and glycemic control. Assessments were at baseline, after treatment, and at the 1-month follow-up.
RESULTS—TheWeb-based CBT was effective in reducing depressive symptoms by intentionto- treat analyses (P = 0.04, d = 0.29; clinical improvement 41% vs. 24% P , 0.001) and by perprotocol analyses (P , 0.001, d = 0.70; clinical improvement, 56% vs. 24% P , 0.001). The intervention reduced diabetes-specific emotional distress (P = 0.03) but had no beneficial effect on glycemic control (P . 0.05).
CONCLUSIONS—Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes. In addition, the intervention reduces diabetes- specific emotional distress in depressed patients.