Activating primary medical care patients for a depression-preventive lifestyle with individualized e-health interventions (ActiLife)

Background:

Subthreshold depressions substantially extend the disease burden of depressive disorders and constitute a risk-factor for full-blown depression. Computer-based counselling-systems using expert-system technology may provide an option to treat large populations at low cost. We present the protocol for a randomized controlled trial testing the effectiveness of a computer-based counselling-system which addresses the motivation to engage in depression preventive behaviors among primary care patients.

Methods:

General practice and general hospital patients will be proactively approached for a computerized health screening to recruit 600 individuals (18 – 64 years) with subthreshold depression or mild major depression in the past 12 months. The intervention group receives three computer-generated individually tailored counselling letters and weekly messages over six months addressing the motivation to engage in depression preventive strategies. The control group participates in assessments only.

Results:

Generalized estimation equation analysis will be used to determine efficacy. The reduction in depressive symptoms at 6 and 12 months after baseline is set as primary outcome. Secondary outcomes include the reappearance of depressive episodes and changes in the use of depression preventive strategies, perceived loneliness, depression related self-stigmatization, health related quality of life, well-being, positive and negative affect, psychosocial impairment as well as other health behaviors.

Conclusion:

Meta-analyses revealed that computer-based self-help systems are effective in reducing depressive symptoms. Although one US-American study yielded encouraging results for an intervention fostering motivation to engage in depression preventive behaviors, so far, no such study existed for a comparable German language system. This trial will make a contribution to the prevention of depressive disorders at an early stage.