Guided digital health intervention for depression in Lebanon: randomised trial

BackgroundMost people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic....

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Veröffentlicht in:BMJ mental health 2022-12, Vol.25 (e1), p.e34-e40
Hauptverfasser: Cuijpers, Pim, Heim, Eva, Ramia, Jinane Abi, Burchert, Sebastian, Carswell, Kenneth, Cornelisz, Ilja, Knaevelsrud, Christine, Noun, Philip, van Klaveren, Chris, van’t Hof, Edith, Zoghbi, Edwina, van Ommeren, Mark, El Chammay, Rabih
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container_end_page e40
container_issue e1
container_start_page e34
container_title BMJ mental health
container_volume 25
creator Cuijpers, Pim
Heim, Eva
Ramia, Jinane Abi
Burchert, Sebastian
Carswell, Kenneth
Cornelisz, Ilja
Knaevelsrud, Christine
Noun, Philip
van Klaveren, Chris
van’t Hof, Edith
Zoghbi, Edwina
van Ommeren, Mark
El Chammay, Rabih
description BackgroundMost people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic.ObjectiveTo examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic.MethodsWe conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.Findings680 people with depression (PHQ-9>10) and impaired functioning (WHODAS>16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up.ConclusionsGuided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition.Clinical implicationsGuided digital mental health interventions should be considered for implementation in LMICs.Trial registration numberClinicalTrials.gov NCT03720769.
doi_str_mv 10.1136/ebmental-2021-300416
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Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic.ObjectiveTo examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic.MethodsWe conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.Findings680 people with depression (PHQ-9&gt;10) and impaired functioning (WHODAS&gt;16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up.ConclusionsGuided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition.Clinical implicationsGuided digital mental health interventions should be considered for implementation in LMICs.Trial registration numberClinicalTrials.gov NCT03720769.</description><identifier>ISSN: 1362-0347</identifier><identifier>EISSN: 1468-960X</identifier><identifier>EISSN: 2755-9734</identifier><identifier>DOI: 10.1136/ebmental-2021-300416</identifier><identifier>PMID: 35577536</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd, Royal College of Psychiatrists and British Psychological Society</publisher><subject>Anxiety ; Coronaviruses ; COVID-19 ; Depression &amp; mood disorders ; Depression - therapy ; Digital Mental Health ; Humans ; Intervention ; Lebanon ; Low income groups ; Mental depression ; Mental disorders ; Mental health ; Pandemics ; Post traumatic stress disorder ; Public health ; Questionnaires ; Self help ; Single-Blind Method ; Well being</subject><ispartof>BMJ mental health, 2022-12, Vol.25 (e1), p.e34-e40</ispartof><rights>Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. 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Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic.ObjectiveTo examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic.MethodsWe conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.Findings680 people with depression (PHQ-9&gt;10) and impaired functioning (WHODAS&gt;16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up.ConclusionsGuided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition.Clinical implicationsGuided digital mental health interventions should be considered for implementation in LMICs.Trial registration numberClinicalTrials.gov NCT03720769.</description><subject>Anxiety</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Depression &amp; mood disorders</subject><subject>Depression - therapy</subject><subject>Digital Mental Health</subject><subject>Humans</subject><subject>Intervention</subject><subject>Lebanon</subject><subject>Low income groups</subject><subject>Mental depression</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Pandemics</subject><subject>Post traumatic stress disorder</subject><subject>Public health</subject><subject>Questionnaires</subject><subject>Self help</subject><subject>Single-Blind Method</subject><subject>Well being</subject><issn>1362-0347</issn><issn>1468-960X</issn><issn>2755-9734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1PAyEQhonR-P0PjNnEi5dVWGC2eDAxjVaTRi-aeCPswrY0W6iw28R_L021fhy8wAy88zDDi9AJwReEULg01dy4TrV5gQuSU4wZgS20TxgMcgH4dTvFFIocU1buoYMYZxinA17uoj3KeVlyCvvocdRbbXSm7cQmWDY1qu2mmXWdCcvEt95ljQ-ZNotgYlyl1mVjUynn3VUWlNN-bmMidMGq9gjtNKqN5vhzP0Qvd7fPw_t8_DR6GN6M84pT0uVUNUWpQAsuGqiMwqppCKgCCK5YBYKbGmOhiOCDolwtFQWmG5Zig2um6SG6XnMXffoGXadOg2rlIti5Cu_SKyt_3zg7lRO_lGJACIZBApx_AoJ_603sZJqiNm2rnPF9lAUA50AIEUl69kc6831waTxZlBwY51ywpGJrVR18jME0m2YIlivD5JdhcmWYXBuWyk5_DrIp-nIoCfBaUM1n3w__y_wAGTKj9A</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Cuijpers, Pim</creator><creator>Heim, Eva</creator><creator>Ramia, Jinane Abi</creator><creator>Burchert, Sebastian</creator><creator>Carswell, Kenneth</creator><creator>Cornelisz, Ilja</creator><creator>Knaevelsrud, Christine</creator><creator>Noun, Philip</creator><creator>van Klaveren, Chris</creator><creator>van’t Hof, Edith</creator><creator>Zoghbi, Edwina</creator><creator>van Ommeren, Mark</creator><creator>El Chammay, Rabih</creator><general>BMJ Publishing Group Ltd, Royal College of Psychiatrists and British Psychological Society</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5497-2743</orcidid></search><sort><creationdate>20221201</creationdate><title>Guided digital health intervention for depression in Lebanon: randomised trial</title><author>Cuijpers, Pim ; Heim, Eva ; Ramia, Jinane Abi ; Burchert, Sebastian ; Carswell, Kenneth ; Cornelisz, Ilja ; Knaevelsrud, Christine ; Noun, Philip ; van Klaveren, Chris ; van’t Hof, Edith ; Zoghbi, Edwina ; van Ommeren, Mark ; El Chammay, Rabih</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b531t-3af27a6d959f6bea0aff16a2610b4b695ec009a1958279582b364df4795e0c4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anxiety</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Depression &amp; mood disorders</topic><topic>Depression - therapy</topic><topic>Digital Mental Health</topic><topic>Humans</topic><topic>Intervention</topic><topic>Lebanon</topic><topic>Low income groups</topic><topic>Mental depression</topic><topic>Mental disorders</topic><topic>Mental health</topic><topic>Pandemics</topic><topic>Post traumatic stress disorder</topic><topic>Public health</topic><topic>Questionnaires</topic><topic>Self help</topic><topic>Single-Blind Method</topic><topic>Well being</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cuijpers, Pim</creatorcontrib><creatorcontrib>Heim, Eva</creatorcontrib><creatorcontrib>Ramia, Jinane Abi</creatorcontrib><creatorcontrib>Burchert, Sebastian</creatorcontrib><creatorcontrib>Carswell, Kenneth</creatorcontrib><creatorcontrib>Cornelisz, Ilja</creatorcontrib><creatorcontrib>Knaevelsrud, Christine</creatorcontrib><creatorcontrib>Noun, Philip</creatorcontrib><creatorcontrib>van Klaveren, Chris</creatorcontrib><creatorcontrib>van’t Hof, Edith</creatorcontrib><creatorcontrib>Zoghbi, Edwina</creatorcontrib><creatorcontrib>van Ommeren, Mark</creatorcontrib><creatorcontrib>El Chammay, Rabih</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health &amp; 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Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic.ObjectiveTo examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic.MethodsWe conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.Findings680 people with depression (PHQ-9&gt;10) and impaired functioning (WHODAS&gt;16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up.ConclusionsGuided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition.Clinical implicationsGuided digital mental health interventions should be considered for implementation in LMICs.Trial registration numberClinicalTrials.gov NCT03720769.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd, Royal College of Psychiatrists and British Psychological Society</pub><pmid>35577536</pmid><doi>10.1136/ebmental-2021-300416</doi><orcidid>https://orcid.org/0000-0001-5497-2743</orcidid><oa>free_for_read</oa></addata></record>
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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; ProQuest Central
subjects Anxiety
Coronaviruses
COVID-19
Depression & mood disorders
Depression - therapy
Digital Mental Health
Humans
Intervention
Lebanon
Low income groups
Mental depression
Mental disorders
Mental health
Pandemics
Post traumatic stress disorder
Public health
Questionnaires
Self help
Single-Blind Method
Well being
title Guided digital health intervention for depression in Lebanon: randomised trial
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