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Background: Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. We hypothesized that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults. Methods: This trial was controlled, randomized and assessor-blinded. Participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14) were recruited from clinical and non-clinical settings and randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity (PHQ-9). The main analysis was based on the intention-to-treat principle and used linear mixed models. Results: A total of 1,013 participants were randomized. Changes in PHQ-9 from baseline differed significantly between groups (t 825 = 6.12, p < 0.001 for the main effect of group). The post-assessment between-group effect size in favour of the intervention was d = 0.39 (95% CI: 0.13-0.64). It was stable at follow-up, with d = 0.32 (95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10). Conclusions: The Internet intervention examined in this trial was superior to CAU alone in reducing mild to moderate depressive symptoms. The magnitude of the effect is clinically important and has public health implications.

Background Borderline Personality Disorder (BPD) is a severe and disabling condition. The Borderline Personality Disorder Checklist (BPDCL) was designed to specifically assess the subjective burden of a patient due to BPD symptoms. Various translations have been developed, but an assessment of the psychometric properties of these translations is needed. The aim was to examine the psychometric qualities of the BPDCL across different languages (i.e., Italian, Dutch, German, Spanish, English, and Greek). Methods Secondary data was used by reaching out to various researchers, who administered the BPDCL in previous studies. Five studies (N = 3199) conducted in Spain, Germany, Italy, the Netherlands, Australia, England, and Greece, were included in the current data set. The BPDCL was administered to BPD patients (N = 1131), Axis I disorder patients (N = 57), patients with other personality disorders (N = 225), and healthy controls (N = 1786). Item analyses and analyses assessing the known‐groups and convergent validity were performed to investigate the psychometric properties of the checklist. Results Each version of the BPDCL, differing in language, demonstrated high‐reliability coefficients (Cronbach's Alpha ranged from 0.93 to 0.96 and was 0.96 for the entire sample). The correlations between the BPDCL and other instruments, used in the studies, were weak to strong. Correlations greater than 0.55 were observed between the BPDCL and the scales BPDSI, SCL‐90 and the BSI. In addition, the BPDCL seems to differentiate well between diagnostic groups. BPD patients scored the highest, followed by patients with other personality disorders, who in turn scored higher than Axis I disorder patients and healthy controls. Conclusions In general, the BPDCL possesses good psychometric properties and seems to be an adequate self‐report instrument to measure the subjective burden of BPD patients.

Introduction: Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. Objective: We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. Methods: Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. Results: Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6–12 weeks; Hedges’ g = 0.39 [95% CI: 0.25–0.53]; follow-up 1: 3–6 months; g = 0.30 [95% CI: 0.15–0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07–0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. Conclusions: Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.

ImportanceBorderline personality disorder (BPD) is a severe mental disorder that is often inadequately treated.ObjectiveTo determine if adding a self-management intervention to care as usual (CAU) is effective and safe.DesignRandomised, controlled, rater-blind trial. Duration of treatment and assessments: 12 months.SettingSecondary care, recruited mainly via the internet.ParticipantsPatients with BPD and BPD Severity Index (BPDSI) of at least 15.InterventionsCAU by treating psychiatrist and/or psychotherapist alone or adjunctive use of an internet-based self-management intervention that is based on schema therapy (priovi).Main outcome measureOutcomes were assessed by trained raters. The primary outcome was change in BPDSI. The safety outcome was the number of serious adverse events (SAEs). The primary outcome time point was 12 months after randomisation.ResultsOf 383 participants assessed for eligibility, 204 were included (91.7% female, mean age: 32.4 years; 74% were in psychotherapy and 26% were in psychiatric treatment). The slope of BPDSI change did not differ significantly between groups from baseline to 12 months (F3,248= 1.857, p=0.14). At 12 months, the within-group effect sizes were d=1.38 (95% CI 1.07 to 1.68) for the intervention group and d=1.02 (95% CI 0.73 to 1.31) for the control group. The between-group effect size was d=0.27 (95% CI 0.00 to 0.55) in the intention-to-treat sample and d=0.39 (95% CI 0.09 to 0.68) for those who used the intervention for at least 3 hours (per-protocol sample). We found no significant differences in SAEs.ConclusionsWe have not found a significant effect in favour of the intervention. This might be due to the unexpectedly large effect in the group receiving CAU by a psychiatrist and/or psychotherapist alone.Trial registrationNCT03418142.

Web-based interventions for individuals with depressive disorders have been a recent focus of research and may be an effective adjunct to face-to-face psychotherapy or pharmacological treatment. The aim of our study was to examine the early change patterns in Web-based interventions to identify differential effects. We applied piecewise growth mixture modeling (PGMM) to identify different latent classes of early change in individuals with mild-to-moderate depression (n=409) who underwent a CBT-based web intervention for depression. Overall, three latent classes were identified (N=409): Two early response classes (n=158, n=185) and one early deterioration class (n=66). Latent classes differed in terms of outcome (P<.001) and adherence (P=.03) in regard to the number of modules (number of modules with a duration of at least 10 minutes) and the number of assessments (P<.001), but not in regard to the overall amount of time using the system. Class membership significantly improved outcome prediction by 24.8% over patient intake characteristics (P<.001) and significantly added to the prediction of adherence (P=.04). These findings suggest that in Web-based interventions outcome and adherence can be predicted by patterns of early change, which can inform treatment decisions and potentially help optimize the allocation of scarce clinical resources.

Background: Evidence on the long-term efficacy of psychotherapeutic approaches for chronic depression is scarce. Objective: To evaluate the effects of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared to Supportive Psychotherapy (SP) 1 year and 2 years after treatment termination. Methods: In this study, we present 1- and 2-year follow-up assessments of a prospective, multicenter, evaluator-blinded, randomized clinical trial of outpatients with early-onset chronic major depression (n = 268). The initial treatment included 32 sessions of CBASP or SP over 48 weeks. The primary outcome was the rate of “well weeks” (Longitudinal Interval Follow-Up Evaluation; no/minimal symptoms) after 1 year and 2 years. The secondary outcomes were, among others, clinician- and self-rated depressive symptoms, response/remission rates, and quality of life. Results: Of the 268 randomized patients, 207 (77%) participated in the follow-up. In the intention-to-treat analysis, there was no statistically significant difference between CBASP and SP patients in experiencing well weeks (CBASP: mean [SD] of 48.6 [36.9] weeks; SP: 39.0 [34.8]; rate ratio 1.26, 95% CI 0.99–1.59, p = 0.057, d = 0.18) and in remission rates (CBASP: 1 year 40%, 2 years 40.2%; SP: 1 year 28.9%, 2 years 33%) in the 2 years after treatment. Statistically significant effects were found in favor of CBASP 1 year after treatment termination regarding the rate of well weeks, self-rated depressive symptoms, and depression-related quality of life. Conclusions: CBASP lost its superiority over SP at some point between the first and the second year. This suggests the necessity of maintenance treatment for early-onset chronically depressed patients remitted with CBASP during the acute therapy phase, as well as the sequential integration of other treatment strategies, including medication for those who did not reach remission.

Intrusive depressive thoughts are typically defined in terms of their content, frequency, and pervasiveness. The extent to which they carry sensory properties is largely unexplored. In a pilot study, 56.5% of individuals with mild to moderate depressive symptoms experienced depressive thoughts with sensory features. The present study explored the prevalence of sensory thoughts in patients with severe depression and examined the stability of the sensory phenomena across time. A total of 163 participants with severe depression completed an online assessment at baseline and 3 months later. Diagnostic status was established at baseline over the telephone. The primary outcome was the Sensory Properties of Depressive Thoughts Questionnaire (SPD). The frequency of sensory properties of negative thoughts was similar (60.7% reported at least one sensory irritation; thus, 39.3% of the sample reported not a single, even mild sensory irritation) to the pilot study. The highest prevalence was observed for bodily sensations (41.1%; pilot: 39.6%) followed by auditory (37.4%; pilot: 30.6%) and visual (31.3%; pilot: 27.2%) perceptions. Prevalence remained essentially unchanged over time, but test–retest reliability was weak to moderate (r = .56). Unlike in the pilot study, no association emerged with quality of life and suicidality. Yet, those reporting sensory phenomena were prescribed more medication, had a similar number of prior hospitalizations despite their younger age, were more frequently in psychotherapy (statistical trend), and had more pain symptoms, which tentatively suggests a more complicated course of illness. Replication in independent samples is needed. Our findings support the notion that depressive thoughts are not “silent” but are commonly accompanied by sensory experiences.

Given the widespread issue of female sexual dysfunction and the scarcity of treatment options, novel therapeutic approaches are needed. This randomized controlled trial evaluated the use of mylovia © , a self-guided digital intervention for female sexual dysfunction and sexual pain disorder based on CBT and mindfulness, in addition to treatment as usual (TAU) compared to TAU plus information material. 252 women participated. At three months, the intervention group showed significantly greater improvements (Cohen’s d  = 0.51, p  < 0.001) in sexual functioning, measured by the Female Sexual Function Index (FSFI), with effects maintained at six months. Clinical relevance was confirmed by Reliable Change Index (RCI) responder analysis. The intervention group also reported greater improvements in sexual desire, satisfaction, and pain-related cognitions and behaviors. There were no significant between-group differences in depressive symptoms or adverse events. The intervention demonstrated comparable efficacy to existing psychosocial treatments, offering a digital therapeutic that could narrow the current gender healthcare gap. This trial was registered on ClinicalTrials.gov on 24 January 2024, with the identifying number NCT06237166.

ObjectiveTo explore the moderating effects of sociodemographic variables on treatment benefits received from participating in an internet intervention for depression.DesignRandomised, assessor-blind, controlled trial.SettingOnline intervention, with participant recruitment using multiple settings, including inpatient and outpatient medical and psychological clinics, depression online forums, health insurance companies and the media (eg, newspaper, radio).ParticipantsThe EVIDENT trial included 1013 participants with mild to moderate depressive symptoms.InterventionsThe intervention group subjects (n=509) received an online intervention (Deprexis) in addition to care as usual (CAU), while 504 participants received CAU alone.MethodsTo explore subgroup differences, moderating effects were investigated using linear regression models based on intention-to-treat analyses. Moderating effects included sex, age, educational attainment, employment status, relationship status and lifetime frequency of episodes.Primary and secondary outcome measuresThe primary endpoint was change in self-rated depression severity measured by the Patient Health Questionnaire-9 (PHQ-9), comparing baseline versus 12-week post-test assessment. Secondary outcome measures were the Hamilton Rating Scale for Depression and the Quick Inventory of Depressive Symptoms each at 12 weeks and at 6 and 12 months, and PHQ-9 at 6 and 12 months, respectively. In this article, we focus on the primary outcome measure only.ResultsBetween-group differences were observed in post-test scores, indicating the effectiveness of Deprexis. While the effects of the intervention could be demonstrated across all subgroups, some showed larger between-group differences than others. However, after exploring the moderating effects based on linear regression models, none of the selected variables was found to be moderating treatment outcomes.ConclusionsOur findings suggest that Deprexis is equally beneficial to a wide range of people; that is, participant characteristics were not associated with treatment benefits. Therefore, participant recruitment into web-based psychotherapeutic interventions should be broad, while special attention may be paid to those currently under-represented in these interventions.Trial registration numberNCT01636752.