Accepted for Publication: December 4, 2019.
Published Online: January 29, 2020. doi:10.1001/jamapsychiatry.2019.4693
Correction: This article was corrected on March 18, 2020, to fix the Conflict of Interest Disclosures and Additional Contributions sections.
Corresponding Author: Zindel V. Segal, PhD, Graduate Department Clinical Psychological Science, University of Toronto Scarborough, Room SY144, 1265 Military Trail, Toronto, ON M1C 1A4, Canada (email@example.com).
Author Contributions: Dr Segal had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.
Concept and design: Segal, Dimidjian, Beck, Boggs, Felder.
Acquisition, analysis, or interpretation of data: Dimidjian, Beck, Boggs, Vanderkruik, Metcalf, Gallop, Levy.
Drafting of the manuscript: Segal, Boggs, Vanderkruik, Gallop.
Critical revision of the manuscript for important intellectual content: Dimidjian, Beck, Boggs, Vanderkruik, Metcalf, Felder, Levy.
Statistical analysis: Vanderkruik, Gallop, Levy.
Obtained funding: Segal, Dimidjian, Beck.
Administrative, technical, or material support: Beck, Boggs, Vanderkruik, Metcalf, Felder, Levy.
Supervision: Dimidjian, Beck.
Conflict of Interest Disclosures: Dr Segal reported being a codeveloper of Mindfulness Based Cognitive Therapy (MBCT) and receiving royalties from Guilford Press for the MBCT treatment manual and patient books; reported presenting keynote addresses at conferences, and MBCT clinical training workshops where he has received a fee, including from the Mind and Life Institute, the Omega Institute, and the University of California San Diego Center for Mindfulness; reported receiving revenue from online MBCT therapist training tools available on mindfulnoggin.com; and reported being a cofounder of Mindful Noggin, Inc, which supports online dissemination of MBCT. Dr Dimidjian reported receiving royalties from Guilford Press for a book based on MBCT for new and expectant mothers; reported presenting at conferences where she received a fee, including from the Mind and Life Institute and Becoming Jackson Whole; reported receiving revenue from online MBCT therapist training tools available on mindfulnoggin.com; and reported being a cofounder of Mindful Noggin, Inc, which supports online dissemination of MBCT. Dr Beck reported receiving grants from the National Institute of Mental Health during the conduct of the study. No other disclosures were reported.
Funding/Support: This work was funded by grant MH102229 (Dr Segal) from the National Institute of Mental Health.
Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 3.
Additional Contributions: Brian Knudson, NogginLabs, worked on the design of Mindful Mood Balance, and Leslie Wright, MA, Angela Plata, MS, Institute for Health Research, Kaiser Permanente Colorado, and Natalie Coleman, BA, Renée Crown Wellness Institute, helped with patient recruitment, tracking, and study management. These individuals were compensated as grant personnel working on this project.
AJ , Charlson
FJ , Norman
et al. Burden of depressive disorders by country, sex, age, and year: findings from the Global Burden of Disease Study 2010. PLoS Med
. 2013;10(11):e1001547. doi:10.1371/journal.pmed.1001547
J , Tomba
E , Fava
GA . The sequential integration of pharmacotherapy and psychotherapy in the treatment of major depressive disorder: a meta-analysis of the sequential model and a critical review of the literature. Am J Psychiatry
. 2016;173(2):128-137. doi:10.1176/appi.ajp.2015.15040476
N , Peeters
F , Huibers
M , van Os
J , Wichers
M . Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: randomised controlled trial. Br J Psychiatry
. 2012;201(4):320-325. doi:10.1192/bjp.bp.111.104851
M , Kane
RL , McAlpine
et al. Integration of mental health/substance abuse and primary care. Rockville, MD: Agency for Healthcare Research and Quality. 2008.
RC , Berglund
P , Demler
et al; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA
. 2003;289(23):3095-3105. doi:10.1001/jama.289.23.3095
G , Issakidis
C , Sanderson
K , Corry
J , Lapsley
H . Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry
. 2004;184(6):526-533. doi:10.1192/bjp.184.6.526
C , Ebert
DD , Lehr
et al. Effect of a web-based guided self-help intervention for prevention of major depression in adults with subthreshold depression: a randomized clinical trial. JAMA
. 2016;315(17):1854-1863. doi:10.1001/jama.2016.4326
F , Bisseling
E , Schellekens
et al. Face-to-face and internet-based mindfulness-based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: a multicenter randomized controlled trial. J Clin Oncol
. 2018;36(23):2413-2421. doi:10.1200/JCO.2017.76.5669
S , Beck
A , Felder
JN , Boggs
JM , Gallop
R , Segal
ZV . Web-based mindfulness-based cognitive therapy for reducing residual depressive symptoms: an open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther
. 2014;63:83-89. doi:10.1016/j.brat.2014.09.004
SAS Institute Inc. SAS® 9.4 Language Reference: Concepts. 5th ed. Cary, NC: SAS Institute Inc; 2016.
ZV , Williams
JM , Teasdale
JD . Mindfulness-Based Cognitive Therapy for Depression. 2nd ed. New York, NY: Guilford Press; 2013.
DV . Adult learners and internet-based distance education. New Dir Adult Contin Educ
. 1998;78:33-41. Google ScholarCrossref
AJ , Trivedi
MH , Wisniewski
et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry
. 2006;163(11):1905-1917. PubMedGoogle ScholarCrossref
B , Benedetti
A , Thombs
BD ; DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire–9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ
. 2019;365:l1476. PubMedGoogle ScholarCrossref
SW , Bryk
AS . Hierarchical Linear Models: Applications and Data Analysis Methods. 2nd ed. London, UK: Sage Publications; 2002.
MB , McCullough
JP , Klein
et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med
. 2000;342(20):1462-1470. PubMedGoogle ScholarCrossref
D . Modelling Survival Data in Medical Research. London, England: Taylor & Francis; 2014.
DB . Multiple imputation for Nonresponse in Surveys. Hoboken, NJ: John Wiley & Sons; 2004.
DC , Lyon
AR , Lattie
EG , Reddy
M , Schueller
SM . Accelerating digital mental health research from early design and creation to successful implementation and sustainment. J Med Internet Res
. 2017;19(5):e153. doi:10.2196/jmir.7725
CH , Chou
LS , Chen
MC , Chen
CC . The relationship between symptom relief and functional improvement during acute fluoxetine treatment for patients with major depressive disorder. J Affect Disord
. 2015;182:115-120. doi:10.1016/j.jad.2015.04.022
JC , Dunlop
BW , Craighead
LW , Nemeroff
CB , Mayberg
HS , Craighead
WE . Follow-up of monotherapy remitters in the PReDICT study: maintenance treatment outcomes and clinical predictors of recurrence. J Consult Clin Psychol
. 2018;86(2):189-199. doi:10.1037/ccp0000279
A , Alpert
J , Wisniewski
et al. Cognitive therapy for anxious depression in STAR(*) D: what have we learned? J Affect Disord
. 2012;142(1-3):213-218. PubMedGoogle ScholarCrossref
DD , Buntrock
C , Lehr
et al. Effectiveness of web- and mobile-based treatment of subthreshold depression with adherence-focused guidance: a single-blind randomized controlled trial. Behav Ther
. 2018;49(1):71-83. doi:10.1016/j.beth.2017.05.004