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Effectiveness of a Guided Web-Based Self-help Intervention to Prevent Depression in Patients With Persistent Back PainThe PROD-BP Randomized Clinical Trial

Educational Objective
To evaluate the effectiveness of a web-based self-help intervention to reduce the incidence of major depressive episode in patients with persistent back pain.
1 Credit CME
Key Points

Question  Can major depression be prevented in routine health care for patients with persistent back pain?

Findings  In this randomized clinical trial of 295 adults with persistent back pain, participants who received a guided, web-based, self-help intervention as an adjunct to treatment as usual showed a significant reduction in the incidence of major depressive episodes over a 12-month period compared with participants who received treatment as usual only.

Meaning  This finding suggests that a proactive, web-based self-help intervention is an appropriate, low-threshold therapy in routine health care that can reduce the incidence of major depressive episodes in patients with persistent back pain.

Abstract

Importance  Depression is a frequent comorbid condition in patients with persistent back pain and is associated with substantial adverse consequences, including the risk of developing opioid use disorders. Shifting the focus from depression treatment to preventing depression might be a viable way to reduce the disease burden.

Objective  To evaluate the effectiveness of a web-based self-help intervention to reduce the incidence of major depressive episode (MDE) in patients with persistent back pain.

Design, Setting, and Participants  Prevention of Depression in Back Pain Patients (PROD-BP) was a pragmatic, observer-blinded randomized clinical trial with a parallel design conducted in Germany. Eligible adults with a diagnosis of persistent back pain and subclinical depressive symptoms, but who were depression free, were recruited either on-site or after discharge from 82 orthopedic clinics between October 1, 2015, and July 31, 2017. All analyses were conducted according to the intention-to-treat principle from October 31, 2018, to April 30, 2019.

Interventions  The intervention group received an e-coach–guided, web-based self-help intervention that was based on cognitive behavioral therapy and tailored to the needs of patients with persistent back pain. The intervention included 6 obligatory modules and 3 optional modules to be completed by participants as well as feedback from e-coaches. Both the intervention and control groups had unrestricted access to treatment as usual.

Main Outcomes and Measures  Primary outcome was time to onset of an MDE over a 12-month period as assessed by blinded diagnostic raters using the Structured Clinical Interview for DSM-5. Secondary outcomes included depression severity, quality of life, pain intensity, pain-related disability, pain self-efficacy, work capacity, and user satisfaction assessed with a variety of instruments.

Results  A total of 295 participants (mean [SD] age, 52.8 [7.7] years; 184 women [62.4%]) were recruited and randomized to either the intervention group (n = 149) or control group (n = 146). The intervention reduced the risk of MDE onset by 52% (hazard ratio, 0.48; 95% CI, 0.28-0.81; P < .001). Twenty-one participants (14.1%) in the intervention group and 41 participants (28.1%) in the control group experienced an MDE over the 12-month period. The number needed to treat to prevent 1 new case of MDE was 2.84 (95% CI, 1.79-9.44).

Conclusions and Relevance  Results of this trial showed that among patients with persistent back pain, depression can be prevented by a guided web-based self-help intervention in addition to treatment as usual. This finding suggests that using a scalable digital approach to integrate psychological treatment into routine pain management is feasible.

Trial Registration  German Clinical Trials Register Identifier: DRKS00007960

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Article Information

Accepted for Publication: March 16, 2020.

Corresponding Author: Lasse B. Sander, PhD, Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs-University of Freiburg, Engelbergerstr 41, 79085 Freiburg, Germany (lasse.sander@psychologie.uni-freiburg.de).

Published Online: May 27, 2020. doi:10.1001/jamapsychiatry.2020.1021

Author Contributions: Drs Sander and Baumeister had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sander, Paganini, Lin, Spanhel, Ebert, Baumeister.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Sander, Terhorst, Lin, Baumeister.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sander, Terhorst, Buntrock.

Obtained funding: Ebert, Baumeister.

Administrative, technical, or material support: Sander, Paganini, Terhorst, Schlicker, Lin, Spanhel, Ebert, Baumeister.

Supervision: Lin, Ebert, Baumeister.

Other—adaption and development of the intervention content and provision of expertise on economic evaluation: Paganini.

Conflict of Interest Disclosures: Dr Sander reported receiving grants from BMBF (Federal Ministry of Education and Research) and DFG (German Research Foundation) during the conduct of the study and personal fees from Psychotherapy Training Institutes outside the submitted work. Dr Paganini reported receiving grants from The German Federal Ministry of Education and Research during the conduct of the study. Dr Schlicker reported receiving grants from BMBF and DFG during the conduct of the study and personal fees from Workshops on E-Mental Health outside the submitted work. Dr Ebert reported holding shares in the GET.On Institut GmbH; receiving personal fees for advice from several companies and health insurance providers and for lectures from psychotherapy and psychiatry associations; and receiving third-party funding from health insurance providers. Dr Baumeister reported receiving grants from BMBF and DFG during the conduct of the study, BARMER Health Insurance, and SVLFG Health Insurance; receiving personal fees from Psychotherapy Chamber, psychotherapy and psychiatry associations, and psychotherapy training institutes outside the submitted work; and being a speaker for E-Mental Health Special Interest Group (SIG) of German Psychological Society, Internet-Based Interventions in Chronic Medical Conditions SIG of ISRII, E-Health Task Force of German Society for Rehabilitation Sciences. No other disclosures were reported.

Funding/Support: This trial was funded by grant 01GY1330 from the German Federal Ministry of Education and Research and grant BA3407/5-1 from the DFG funded the trial.

Role of the Funder/Sponsor: The funders 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: We thank colleagues and study assistants for being part of the development of previous interventions that partly form the basis of eSano BackCare-DP. Jürgen Bengel, PhD, Kristin Kieselbach, PhD, and Anja Göritz, PhD, Albert-Ludwigs-University of Freiburg, provided their expertise in the treatment of chronic pain patients. Ellen Meierotto, Dipl.-Psych., supervised the SCID interviewers. Julian Mack, MSc Psych, Albert-Ludwigs-University of Freiburg, and Anna Fritz, BSc Psych, assisted with data analysis and final review of the manuscript. The Clinical Trial Unit Freiburg and an independent Data and Safety Monitoring Board comprising researchers not involved in the study (Martin Hautzinger, PhD, Martin Härter, PhD, and Levente Kriston, PhD) oversaw and monitored the trial; Christina Ramsenthaler, PhD, Albert-Ludwigs-University of Freiburg, proofread the manuscript. These individuals received no additional compensation, outside of their usual salary, for their contributions. Thank you to the following orthopedic rehabilitation facilities for their cooperation during the on-site participant recruitment: Schoen Klinik, Bad Staffelstein; Rehaklinik Sonnhalde, Donaueschingen; RehaKlinikum Bad Säckingen; Städt. Rehakliniken Bad Waldsee; Schwarzwaldklinik Orthopädie–Abteilung Medizinische Rehabilitation, Bad Krozingen; Rheintalklinik Bad Krozingen; REGIO-Reha Tagesklinik, Freiburg; and Universitäts-und Rehabilitationskliniken, Ulm. Thank you to the following orthopedic rehabilitation units involved in the second recruitment strategy: Ambulantes Rehabilitationszentrum Bautzen; Medical Park Am Kirschbaumhügel, Bad Wiessee; Klinik Wendelstein, Bad Aibling; Edith Stein Fachklinik, Bad Bergzabern; ZAR Zentrum für ambulante Rehabilitation im MineralBad Cannstatt, Bad Cannstatt; Caspar Heinrich Klinik, Bad Driburg; Rehazentrum Bad Eilsen; Fachklinik und Moorbad Bad Freienwalde; Orthopädie-Zentrum Bad Füssing; Paracelsus-Klinik an der Gande, Bad Gandersheim; HolsingVital, Bad Holzhausen; Deegenbergklinik, Bad Kissingen; Frankenklinik Bad Kissingen; Mittelbayerisches Rehabiliatationszentrum Klinik Luitpold Klinik Maximilian, Bad Kötzting; Kurpark Klinik, Bad Nauheim; Klinik Niedersachsen, Bad Nenndorf; Landgrafen Klinik, Bad Nenndorf; MediClin Schlüsselbad Klinik, Bad Peterstal-Griesbach; Klinik der Fürstenhof, Bad Pyrmont; Klinik Weser, Bad Pyrmont; Klinik Münsterland, Bad Rothenfelde; Klinik am Park, Bad Sassendorf; Klinik Lindenplatz, Bad Sassendorf; Klinik Dübener Heide, Bad Schmiedeberg; Asklepios Klinik Am Kurpark, Bad Schwartau; Klinik Hoher Meissner, Bad Sooden-Allendorf; Klinik Werra, Bad Sooden-Allendorf; THERAmed Zentrum für Therapie und Gesundheit, Bad Staffelstein; Reha-Zentrum Bad Steben; Klinik Birkental, Bad Wildungen; MediClin Klinik für Akutpsychosomatik und Reha-Zentrum am Hahnberg, Bad Wildungen; Rheumaklinik Bad Wildungen; Klinik Dr Franz Dengler, Baden-Baden; REHA Baunatal; Gesundheitszentrum Prenzlauer Berg, Berlin; MEDIAN Klinik Berlin Kladow, Berlin; Reha Tagesklinik im Forum Pankow, Berlin; ZAR, Berlin; Reha-Zentrum HESS, Bietigheim-Bissingen; Klinik und Rehabiliationszentrum Lippoldsberg, Bodenfelde; Vitalis, Brandenburg; Fachklinikum Brandis; Gesundheitszentrum Lang, Dinslaken; Klinik Königsfeld, Ennepetal; REHAKTIV-Oberberg, Gummersbach; Gesundheitszentrum Hannover; Ortho-Mobile Hattingen; Kurparkklinik Heilbad Heiligenstadt; Fachklinik Herzogenaurach; Therapiezentrum Schmerz weg, Hofheim; Fachklinik Enzensberg, Hopfen am See; Tagesklinik für Rehabilitation und Prävention, Hoyerswerda; Fachklinik Ichenhausen; Reha Vital, Ingelheim; Argentalklinik, Isny; ZANR Kaiserslautern; Ambulantes Zentrum für Rehabilitation und Prävention am Entenfang, Karlsruhe; Sport Reha Kiel; Therapiezentrum Brüderhaus, Koblenz; UniReha, Köln; Salvea Krefeld; MediClin Hedon Klinik, Lingen; Tagesklinik am Kurpark, Lüneburg; MEDIAN Saale Klinik, Bad Kösen; Medicos, Osnabrück; Asklepios Klinik, Schaufling; MEDIAN Klinik, Schlangenbad; Schön Klinik Berchtesgadener Land, Schönau am Königssee; MediClin Klinikum, Soltau; Ziegelfeld-Klinik, St Blasien; rehamed Stuttgart; Gesundheitszentrum Chiemgau, Traunstein; MEDIAN Rehaklinik Aukammtal, Wiesbaden; Impuls Reha- und Gesundheitszentrum, Würzburg.

References
1.
Institute for Health Metrics and Evaluation (IHME). Findings from the Global Burden of Disease Study 2017. Published January 4, 2019. Accessed May 1, 2019. http://www.healthdata.org/policy-report/findings-global-burden-disease-study-2017
2.
Hoy  D , March  L , Woolf  A ,  et al.  The global burden of neck pain: estimates from the Global Burden of Disease 2010 study.   Ann Rheum Dis. 2014;73(7):1309-1315. doi:10.1136/annrheumdis-2013-204431 PubMedGoogle Scholar
3.
Broadhead  WE , Blazer  DG , George  LK , Tse  CK .  Depression, disability days, and days lost from work in a prospective epidemiologic survey.   JAMA. 1990;264(19):2524-2528. doi:10.1001/jama.1990.03450190056028 PubMedGoogle Scholar
4.
Rice  ASC , Smith  BH , Blyth  FM .  Pain and the global burden of disease.   Pain. 2016;157(4):791-796. doi:10.1097/j.pain.0000000000000454 PubMedGoogle Scholar
5.
Von Korff  M , Crane  P , Lane  M ,  et al.  Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication.   Pain. 2005;113(3):331-339. doi:10.1016/j.pain.2004.11.010 PubMedGoogle Scholar
6.
Costa  L da CM , Maher  CG , McAuley  JH ,  et al.  Prognosis for patients with chronic low back pain: inception cohort study.   BMJ. 2009;339:b3829. doi:10.1136/bmj.b3829 PubMedGoogle Scholar
7.
Bair  MJ , Robinson  RL , Katon  W , Kroenke  K .  Depression and pain comorbidity: a literature review.   Arch Intern Med. 2003;163(20):2433-2445. doi:10.1001/archinte.163.20.2433 PubMedGoogle Scholar
8.
Linton  SJ , Bergbom  S .  Understanding the link between depression and pain.   Scand J Pain. 2011;2(2):47-54. doi:10.1016/j.sjpain.2011.01.005 PubMedGoogle Scholar
9.
Pincus  T , Burton  AK , Vogel  S , Field  AP .  A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain.   Spine (Phila Pa 1976). 2002;27(5):E109-E120. doi:10.1097/00007632-200203010-00017 PubMedGoogle Scholar
10.
Arnow  BA , Blasey  CM , Lee  J ,  et al.  Relationships among depression, chronic pain, chronic disabling pain, and medical costs.   Psychiatr Serv. 2009;60(3):344-350. doi:10.1176/ps.2009.60.3.344 PubMedGoogle Scholar
11.
Edwards  RR , Dworkin  RH , Sullivan  MD , Turk  DC , Wasan  AD .  The role of psychosocial processes in the development and maintenance of chronic pain.   J Pain. 2016;17(9 suppl):T70-T92. doi:10.1016/j.jpain.2016.01.001 PubMedGoogle Scholar
12.
Goldberg  D .  The detection and treatment of depression in the physically ill.   World Psychiatry. 2010;9(1):16-20. doi:10.1002/j.2051-5545.2010.tb00256.x PubMedGoogle Scholar
13.
Volkow  ND , Icaza  MEM , Poznyak  V , Saxena  S , Gerra  G ; UNODC-WHO Informal Scientific Network.  Addressing the opioid crisis globally.   World Psychiatry. 2019;18(2):231-232. doi:10.1002/wps.20633 PubMedGoogle Scholar
14.
Volkow  ND , McLellan  AT .  Opioid abuse in chronic pain—misconceptions and mitigation strategies.   N Engl J Med. 2016;374(13):1253-1263. doi:10.1056/NEJMra1507771 PubMedGoogle Scholar
15.
Cheatle  MD .  Depression, chronic pain, and suicide by overdose: on the edge.   Pain Med. 2011;12(suppl 2):S43-S48. doi:10.1111/j.1526-4637.2011.01131.x PubMedGoogle Scholar
16.
Dowell  D , Haegerich  TM , Chou  R .  CDC guideline for prescribing opioids for chronic pain–United States, 2016.   JAMA. 2016;315(15):1624-1645. doi:10.1001/jama.2016.1464 PubMedGoogle Scholar
17.
Cuijpers  P , Beekman  ATF , Reynolds  CF  III .  Preventing depression: a global priority.   JAMA. 2012;307(10):1033-1034. doi:10.1001/jama.2012.271 PubMedGoogle Scholar
18.
Muñoz  RF , Bunge  EL .  Prevention of depression worldwide: a wake-up call.   Lancet Psychiatry. 2016;3(4):306-307. doi:10.1016/S2215-0366(15)00555-6 PubMedGoogle Scholar
19.
Thapar  A , Collishaw  S , Potter  R , Thapar  AK .  Managing and preventing depression in adolescents.   BMJ. 2010;340:c209. doi:10.1136/bmj.c209 PubMedGoogle Scholar
20.
Ebert  DD , Cuijpers  P .  It is time to invest in the prevention of depression.   JAMA Netw Open. 2018;1(2):e180335. doi:10.1001/jamanetworkopen.2018.0335 PubMedGoogle Scholar
21.
Curry  SJ , Krist  AH , Owens  DK ,  et al; US Preventive Services Task Force.  Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement.   JAMA. 2019;321(6):580-587. doi:10.1001/jama.2019.0007 PubMedGoogle Scholar
22.
van Zoonen  K , Buntrock  C , Ebert  DD ,  et al.  Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions.   Int J Epidemiol. 2014;43(2):318-329. doi:10.1093/ije/dyt175 PubMedGoogle Scholar
23.
Merry  SN , Hetrick  SE , Cox  GR , Brudevold-Iversen  T , Bir  JJ , McDowell  H .  Psychological and educational interventions for preventing depression in children and adolescents.   Cochrane Database Syst Rev. 2011;(12):CD003380. doi:10.1002/14651858.CD003380.pub3 PubMedGoogle Scholar
24.
Brent  DA , Brunwasser  SM , Hollon  SD ,  et al.  Effect of a cognitive-behavioral prevention program on depression 6 years after implementation among at-risk adolescents: a randomized clinical trial.   JAMA Psychiatry. 2015;72(11):1110-1118. doi:10.1001/jamapsychiatry.2015.1559 PubMedGoogle Scholar
25.
Ormel  J , Cuijpers  P , Jorm  AF , Schoevers  R .  Prevention of depression will only succeed when it is structurally embedded and targets big determinants.   World Psychiatry. 2019;18(1):111-112. doi:10.1002/wps.20580 PubMedGoogle Scholar
26.
Arango  C , Díaz-Caneja  CM , McGorry  PD ,  et al.  Preventive strategies for mental health.   Lancet Psychiatry. 2018;5(7):591-604. doi:10.1016/S2215-0366(18)30057-9 PubMedGoogle Scholar
27.
Foster  NE , Anema  JR , Cherkin  D ,  et al; Lancet Low Back Pain Series Working Group.  Prevention and treatment of low back pain: evidence, challenges, and promising directions.   Lancet. 2018;391(10137):2368-2383. doi:10.1016/S0140-6736(18)30489-6 PubMedGoogle Scholar
28.
Narasimhan  M , Allotey  P , Hardon  A .  Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance.   BMJ. 2019;365:l688. doi:10.1136/bmj.l688 PubMedGoogle Scholar
29.
Fineberg  HV .  Shattuck lecture. A successful and sustainable health system—how to get there from here.   N Engl J Med. 2012;366(11):1020-1027. doi:10.1056/NEJMsa1114777 PubMedGoogle Scholar
30.
Becker  AE , Kleinman  A .  Mental health and the global agenda.   N Engl J Med. 2013;369(1):66-73. doi:10.1056/NEJMra1110827 PubMedGoogle Scholar
31.
Das  P , Naylor  C , Majeed  A .  Bringing together physical and mental health within primary care: a new frontier for integrated care.   J R Soc Med. 2016;109(10):364-366. doi:10.1177/0141076816665270 PubMedGoogle Scholar
32.
Shrank  WH , Rogstad  TL , Parekh  N .  Waste in the US health care system: estimated costs and potential for savings.   JAMA. 2019;322(15):1501-1509. doi:10.1001/jama.2019.13978 PubMedGoogle Scholar
33.
Hedman  E .  Therapist guided internet delivered cognitive behavioural therapy.   BMJ. 2014;348:g1977. doi:10.1136/bmj.g1977 PubMedGoogle Scholar
34.
Singla  DR , Raviola  G , Patel  V .  Scaling up psychological treatments for common mental disorders: a call to action.   World Psychiatry. 2018;17(2):226-227. doi:10.1002/wps.20532 PubMedGoogle Scholar
35.
Andersson  G , Titov  N , Dear  BF , Rozental  A , Carlbring  P .  Internet-delivered psychological treatments: from innovation to implementation.   World Psychiatry. 2019;18(1):20-28. doi:10.1002/wps.20610 PubMedGoogle Scholar
36.
Titov  N , Hadjistavropoulos  HD , Nielssen  O , Mohr  DC , Andersson  G , Dear  BF .  From research to practice: ten lessons in delivering digital mental health services.   J Clin Med. 2019;8(8):E1239. doi:10.3390/jcm8081239 PubMedGoogle Scholar
37.
Andrews  G , Hobbs  MJ .  Pragmatic treatment options for depression and anxiety disorders are needed.   World Psychiatry. 2016;15(3):241-242. doi:10.1002/wps.20364 PubMedGoogle Scholar
38.
Buntrock  C , Ebert  DD , Lehr  D ,  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 PubMedGoogle Scholar
39.
Barnett  K , Mercer  SW , Norbury  M , Watt  G , Wyke  S , Guthrie  B .  Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.   Lancet. 2012;380(9836):37-43. doi:10.1016/S0140-6736(12)60240-2 PubMedGoogle Scholar
40.
Weiss  CO , Boyd  CM , Yu  Q , Wolff  JL , Leff  B .  Patterns of prevalent major chronic disease among older adults in the United States.   JAMA. 2007;298(10):1160-1162. doi:10.1001/jama.298.10.1160-b PubMedGoogle Scholar
41.
Makris  UE , Abrams  RC , Gurland  B , Reid  MC .  Management of persistent pain in the older patient: a clinical review.   JAMA. 2014;312(8):825-836. doi:10.1001/jama.2014.9405 PubMedGoogle Scholar
42.
Sander  L , Paganini  S , Lin  J ,  et al.  Effectiveness and cost-effectiveness of a guided Internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain-study protocol of the PROD-BP multicenter pragmatic RCT.   BMC Psychiatry. 2017;17(1):36. doi:10.1186/s12888-017-1193-6 PubMedGoogle Scholar
43.
Löwe  B , Kroenke  K , Herzog  W , Gräfe  K , Gräfe  K .  Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9).   J Affect Disord. 2004;81(1):61-66. doi:10.1016/S0165-0327(03)00198-8 PubMedGoogle Scholar
44.
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
45.
Kupfer  DJ .  Long-term treatment of depression.   J Clin Psychiatry. 1991;52(suppl):28-34.PubMedGoogle Scholar
46.
First  M , Williams  J , Karg  R , Spitzer  R .  Structured Clinical Interview for DSM-5: Research Version (SCID-5-RV). American Psychiatric Association; 2015.
47.
German Medical Association, National Association of Statutory Health Insurance Physicians, Association of Scientific Medical Societies. National Disease Management Guideline: low back pain, short version. 1st ed. Version 5. Amended October 2015. Accessed May 1, 2019. https://www.leitlinien.de/mdb/downloads/nvl/kreuzschmerz/archiv/kreuzschmerz-1aufl-vers5-short.pdf
48.
Bouwmans  C , De Jong  K , Timman  R ,  et al.  Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P).   BMC Health Serv Res. 2013;13(1):217. doi:10.1186/1472-6963-13-217 PubMedGoogle Scholar
49.
Hamilton  M .  A rating scale for depression.   J Neurol Neurosurg Psychiatry. 1960;23:56-62. doi:10.1136/jnnp.23.1.56 PubMedGoogle Scholar
50.
Rush  AJ , Trivedi  MH , Ibrahim  HM ,  et al.  The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), Clinician Rating (QIDS-C), and Self-Report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.   Biol Psychiatry. 2003;54(5):573-583. doi:10.1016/S0006-3223(02)01866-8 PubMedGoogle Scholar
51.
Lyketsos  C , Nestadt  G , Cwi  J , Heithoff  K , Eaton  W .  The life chart interview: a standardized method to describe the course of psychopathology.   Int J Methods Psychiatr Res. 1994;4:143-155.Google Scholar
52.
Richardson  JR , Peacock  SJ , Hawthorne  G , Iezzi  A , Elsworth  G , Day  NA .  Construction of the descriptive system for the Assessment of Quality of Life AQoL-6D utility instrument.   Health Qual Life Outcomes. 2012;10(1):38-46. doi:10.1186/1477-7525-10-38 PubMedGoogle Scholar
53.
Dworkin  RH , Turk  DC , Wyrwich  KW ,  et al.  Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations.   J Pain. 2008;9(2):105-121. doi:10.1016/j.jpain.2007.09.005 PubMedGoogle Scholar
54.
Mannion  AF , Junge  A , Grob  D , Dvorak  J , Fairbank  JCT .  Development of a German version of the Oswestry Disability Index, part 2: sensitivity to change after spinal surgery.   Eur Spine J. 2006;15(1):66-73. doi:10.1007/s00586-004-0816-z PubMedGoogle Scholar
55.
Nicholas  MK .  The pain self-efficacy questionnaire: taking pain into account.   Eur J Pain. 2007;11(2):153-163. doi:10.1016/j.ejpain.2005.12.008 PubMedGoogle Scholar
56.
Mittag  O , Raspe  H .  A brief scale for measuring subjective prognosis of gainful employment: findings of a study of 4279 statutory pension insurees concerning reliability (Guttman scaling) and validity of the scale [in German].   Rehabilitation (Stuttg). 2003;42(3):169-174. doi:10.1055/s-2003-40095PubMedGoogle Scholar
57.
Boß  L , Lehr  D , Reis  D ,  et al.  Reliability and validity of assessing user satisfaction with web-based health interventions.   J Med internet Res. 2016;18(8):e234. doi:10.2196/jmir.5952 PubMedGoogle Scholar
58.
Ladwig  I , Rief  W , Nestoriuc  Y .  What are the risks and side effects of psychotherapy? development of an Inventory for the Assessment of Negative Effects of Psychotherapy (INEP).   Verhaltenstherapie. 2014;24(4):252-264. doi:10.1159/000367928Google Scholar
59.
Kraemer  HC , Kupfer  DJ .  Size of treatment effects and their importance to clinical research and practice.   Biol Psychiatry. 2006;59(11):990-996. doi:10.1016/j.biopsych.2005.09.014 PubMedGoogle Scholar
60.
Trajković  G , Starčević  V , Latas  M ,  et al.  Reliability of the Hamilton Rating Scale for Depression: a meta-analysis over a period of 49 years.   Psychiatry Res. 2011;189(1):1-9. doi:10.1016/j.psychres.2010.12.007 PubMedGoogle Scholar
61.
International Standard Classification of Education. Education Statistics (EdStats). Accessed April 20, 2020. https://datatopics.worldbank.org/education/wRsc/classification
62.
Newcombe  RG .  Interval estimation for the difference between independent proportions: comparison of eleven methods.   Stat Med. 1998;17(8):873-890. doi:10.1002/(SICI)1097-0258(19980430)17:8<873::AID-SIM779>3.0.CO;2-I PubMedGoogle Scholar
63.
Beekman  AT , Smit  F , Stek  ML , Reynolds  CF  III , Cuijpers  PC .  Preventing depression in high-risk groups.   Curr Opin Psychiatry. 2010;23(1):8-11. doi:10.1097/YCO.0b013e328333e17f PubMedGoogle Scholar
64.
Donker  T , Blankers  M , Hedman  E , Ljótsson  B , Petrie  K , Christensen  H .  Economic evaluations of internet interventions for mental health: a systematic review.   Psychol Med. 2015;45(16):3357-3376. doi:10.1017/S0033291715001427 PubMedGoogle Scholar
65.
Paganini  S , Teigelkötter  W , Buntrock  C , Baumeister  H .  Economic evaluations of internet- and mobile-based interventions for the treatment and prevention of depression: a systematic review.   J Affect Disord. 2018;225:733-755. doi:10.1016/j.jad.2017.07.018 PubMedGoogle Scholar
66.
Shim  M , Mahaffey  B , Bleidistel  M , Gonzalez  A .  A scoping review of human-support factors in the context of Internet-based Psychological Interventions (IPIs) for depression and anxiety disorders.   Clin Psychol Rev. 2017;57:129-140. doi:10.1016/j.cpr.2017.09.003 PubMedGoogle Scholar
67.
Dionne  CE , Von Korff  M , Koepsell  TD , Deyo  RA , Barlow  WE , Checkoway  H .  Formal education and back pain: a review.   J Epidemiol Community Health. 2001;55(7):455-468. doi:10.1136/jech.55.7.455 PubMedGoogle Scholar
68.
Kessler  RC , Demler  O , Frank  RG ,  et al.  Prevalence and treatment of mental disorders, 1990 to 2003.   N Engl J Med. 2005;352(24):2515-2523. doi:10.1056/NEJMsa043266 PubMedGoogle Scholar
69.
Wang  PS , Lane  M , Olfson  M , Pincus  HA , Wells  KB , Kessler  RC .  Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication.   Arch Gen Psychiatry. 2005;62(6):629-640. doi:10.1001/archpsyc.62.6.629 PubMedGoogle Scholar
70.
Karyotaki  E , Riper  H , Twisk  J ,  et al.  Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of individual participant data.   JAMA Psychiatry. 2017;74(4):351-359. doi:10.1001/jamapsychiatry.2017.0044 PubMedGoogle Scholar
71.
Andersson  G , Titov  N .  Advantages and limitations of internet-based interventions for common mental disorders.   World Psychiatry. 2014;13(1):4-11. doi:10.1002/wps.20083 PubMedGoogle Scholar
72.
Gilbody  S , Littlewood  E , Hewitt  C ,  et al; REEACT Team.  Computerised Cognitive Behaviour Therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial.   BMJ. 2015;351:h5627. doi:10.1136/bmj.h5627 PubMedGoogle Scholar
73.
Cuijpers  P , van Straten  A , Bohlmeijer  E , Hollon  SD , Andersson  G .  The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size.   Psychol Med. 2010;40(2):211-223. doi:10.1017/S0033291709006114 PubMedGoogle Scholar
74.
Hempel  S , Suttorp  MJ , Miles  JN ,  et al.  Empirical Evidence of Associations Between Trial Quality and Effect Size. Agency for Healthcare Research and Quality; 2011.
75.
Rutherford  BR , Wager  TD , Roose  SP .  Expectancy and the treatment of depression: a review of experimental methodology and effects on patient outcome.   Curr Psychiatry Rev. 2010;6(1):1-10. doi:10.2174/157340010790596571 PubMedGoogle Scholar
76.
Greenberg  RP , Constantino  MJ , Bruce  N .  Are patient expectations still relevant for psychotherapy process and outcome?   Clin Psychol Rev. 2006;26(6):657-678. doi:10.1016/j.cpr.2005.03.002 PubMedGoogle Scholar
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