Decreasing Major Depressive Episodes Through Online Interventions

The World Health Organization estimates that 5% of adults experience depression worldwide. Depression is different from feelings of sadness for several reasons. While sadness tends to be short-lived, depression lasts for two weeks or more and can have serious symptoms that affect a person in numerous ways. In addition, depression can significantly impair a person’s day-to-day functioning. However, there are effective treatments available, including therapy and medication.

Below, we’ll discuss major depressive episodes and online interventions to reduce depression symptoms and improve overall well-being.

Major depressive episodes

While all major depressive episodes are a type of depression, not all depression symptoms lead to a diagnosis of a major depressive episode. Harvard Health Publishing identifies six different types of depression, including major depression. This is the most commonly recognized type of depression and is often characterized by a constant dark mood and loss of interest in activities. Other depression symptoms may include changes in sleep patterns (sleeping too much or too little), weight loss or gain, and suicidal thoughts.*

*If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7.

Despite these high numbers, one in three adults experiencing a major depressive episode did not seek treatment in the past year, yet effective treatments are available. Care can often include one or more treatments, including antidepressants, cognitive behavioral therapy (CBT), interpersonal therapy, psychodynamic counseling, or a combination.

Online CBT and its impact on incidence of major depressive episodes

Although CBT has been proven to be effective for major depressive episodes, several barriers often limit individuals from seeking this therapy. Providing CBT requires having trained professionals available to serve a community, which is not always the case, especially in smaller or more rural areas. Also, sometimes stigmas associated with mental health challenges can prevent treatment. In addition, limited time, money, and transportation can be barriers to CBT.

Internet-based cognitive-behavioral therapy (iCBT) is an increasingly popular treatment that bypasses many barriers. The virtual nature of iCBT often allows for greater flexibility, and several studies have examined its effectiveness in reducing depression symptoms in various populations or preventing its incidence altogether.

Research on online interventions for depression

One study on depression in workers in Japan examined whether a specific iCBT program decreased symptoms of subthreshold depression.

Participants

Approximately 1,790 individuals were recruited from two information technology companies in Japan during 2011. Recruitment occurred through invitation emails sent by company management. Exclusion criteria included:

• Diagnosis of a major depressive episode within the past month (which was determined by using an online, self-administered version of the WHO Composite International Diagnostic Interview 3.0)
• Diagnosis of lifetime bipolar disorder
• Sick leave of 15 or more days due to personal health issues in the past three months
• Medical treatments for mental health problems within the past month

Out of the 850 individuals who opted to complete a baseline survey, 762 participants fulfilled the inclusion criteria. They were randomly placed within the intervention and control groups, with 381 in each.

The intervention

Those in the intervention group were provided a six-week, six-lesson virtual CBT program covering self-monitoring, cognitive restructuring, assertiveness, problem-solving, and relaxation. Homework was submitted voluntarily, and those who did complete the homework received feedback from trained psychologists. Five clinical psychologists provided feedback on a first-come, first-served basis as homework was submitted.

Participants in the intervention group were asked to finish the program within 10 weeks of the baseline survey. Email reminders prompted them to complete lessons and homework, but no incentives were provided. Also, company management was not informed who completed their lessons and who didn’t.

Those in the control group received monthly emails about non-CBT stress management tips for the six months following the baseline survey. These emails covered topics such as forming healthy sleep habits and limiting alcohol intake. In addition, all employees from one of the two IT companies were provided a virtual session on stress management. After the six-month follow-up, people in the control group were given entry to the iCBT program.

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Results

Among those who responded at follow-up, participants in the intervention group experienced more significant improvement in depression symptoms at three-month follow-up than participants in the control group. This study suggests that online interventions can be effective for non-clinical populations experiencing subthreshold depression symptoms.

Reducing the incidence of major depressive episodes

Reducing the incidence of major depressive episodes often involves both prevention and treatment. Ideally, the goal is to prevent many people from ever experiencing depression by offering preventive care and education. However, for those who have already experienced or currently have major depression, treatment can be used to reduce symptoms and the duration of major episodes.

Speaking to a licensed therapist can be an important part of treating or preventing major depressive episodes. For those whose depression symptoms make it challenging to leave home, online interventions can be effective for reducing their symptoms. The methods below include both preventive measures and treatment options for major depression.

Resilience development

One factor that may help prevent major depressive episodes is the development of resiliency. Resilience prepares individuals to overcome hardships in life, and those with low levels of resilience may be more prone to mental health challenges. The Center on the Developing Child at Harvard asserts that the most important factor in developing resilience is at least one stable relationship with a caring adult, such as a parent, family member, or teacher.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) can serve as an effective treatment for depressive episodes, and it can be delivered online. Many studies have examined the efficacy of internet-delivered CBT (ICBT) and found it to be effective for depression and other mental health conditions, including generalized anxiety disorder.

Family cognitive behavioral intervention

One of the risk factors for depression is parental depression. A method that addresses depression in caregivers acts as both prevention for possible future episodes and treatment for current episodes of depression. One study found that using a family-focused method to work with children and their parents who had a history of depression reduced symptoms significantly. Per the study, “Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures.”