RT Journal Article
T1 An Internet-Based Intervention for Depression in Primary Care in Spain: A Randomized Controlled Trial.
A1 Montero-Marin, Jesus
A1 Araya, Ricardo
A1 Perez-Yus, Maria C
A1 Mayoral, Fermin
A1 Gili, Margalida
A1 Botella, Cristina
A1 Baños, Rosa
A1 Castro, Adoracion
A1 Romero-Sanchiz, Pablo
A1 Lopez-Del-Hoyo, Yolanda
A1 Nogueira-Arjona, Raquel
A1 Vives, Margarita
A1 Riera, Antoni
A1 Garcia-Campayo, Javier
K1 Depression
K1 Primary Health Care
K1 Effectiveness
K1 Internet-Based Intervention
K1 Multilevel Analysis
AB Depression is the most prevalent cause of illness-induced disability worldwide. Face-to-face psychotherapeutic interventions for depression can be challenging, so there is a need for other alternatives that allow these interventions to be offered. One feasible alternative is Internet-based psychological interventions. This is the first randomized controlled trial (RCT) on the effectiveness of an Internet-based intervention on depression in primary health care in Spain. Our aim was to compare the effectiveness of a low-intensity therapist-guided (LITG) Internet-based program and a completely self-guided (CSG) Internet-based program with improved treatment as usual (iTAU) care for depression. Multicenter, three-arm, parallel, RCT design, carried out between November 2012 and January 2014, with a follow-up of 15 months. In total, 296 adults from primary care settings in four Spanish regions, with mild or moderate major depression, were randomized to LITG (n=96), CSG (n=98), or iTAU (n=102). Research completers at follow-up were 63.5%. The intervention was Smiling is Fun, an Internet program based on cognitive behavioral therapy. All patients received iTAU by their general practitioners. Moreover, LITG received Smiling is Fun and the possibility of psychotherapeutic support on request by email, whereas CSG received only Smiling is Fun. The main outcome was the Beck Depression Inventory-II at 3 months from baseline. Mixed-effects multilevel analysis for repeated measures were undertaken. There was no benefit for either CSG [(B coefficient=-1.15; P=.444)] or LITG [(B=-0.71; P=.634)] compared to iTAU, at 3 months. There were differences at 6 months [iTAU vs CSG (B=-4.22; P=.007); iTAU vs LITG (B=-4.34; P=.005)] and 15 months [iTAU vs CSG (B=-5.10; P=.001); iTAU vs LITG (B=-4.62; P=.002)]. There were no differences between CSG and LITG at any time. Adjusted and intention-to-treat models confirmed these findings. An Internet-based intervention for depression combined with iTAU conferred a benefit over iTAU alone in the Spanish primary health care system. 
PB JMIR Publications
YR 2016
FD 2016-08-26
LK http://hdl.handle.net/10668/10395
UL http://hdl.handle.net/10668/10395
LA en
NO Montero-Marín J, Araya R, Pérez-Yus MC, Mayoral F, Gili M, Botella C, et al. An Internet-Based Intervention for Depression in Primary Care in Spain: A Randomized Controlled Trial. J Med Internet Res. 2016 Aug 26;18(8):e231.
DS RISalud
RD Apr 10, 2025