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‘Low-intensity’ interventions may help severely depressed patients

Patients with severe depression benefited as much from low-intensity interventions, such as self-help books and interactive websites, as patients with less severe depression, researchers reported. The findings indicate that severe depression can be treated using a stepped-care approach.

“The lack of clinically meaningful differences in treatment effects related to baseline severity would suggest that it is legitimate to include low-intensity interventions in the first step of a stepped-care system and to encourage most patients to use them as the initial treatment option, even when initial severity of depression is high,” the researchers wrote.

Peter Bower, PhD, professor of health services research at the University of Manchester, England, and colleagues performed a meta-analysis of 16 studies conducted from 2000 or later in which low-intensity interventions were compared with treatment as usual. A total of 2,470 patients with varying depression severity were included in the analysis.

Low-intensity interventions were defined in the study “as those designed to help patients manage depressive symptoms, primarily using a health technology such as self-help books, instructional videos, or interactive interventions using information technology.” Almost all of the studies in the meta-analysis used the Beck Depression Inventory (BDI) or the Center for Epidemiologic Studies Depression Scale (CES-D) as the main depression outcome.

Many of the patients who had moderate to severe depression at baseline were referred to low-intensity interventions, according to the researchers. The overall estimated treatment effect of low-intensity interventions was –0.42 (95% CI, –0.55 to –0.29), the equivalent to a reduction of approximately four or five points in BDI and CES-D scores.

There was a significant interaction between depression severity and treatment effect (coefficient –0.1; 95% CI, –0.19 to –0.002), indicating that patients with severe depression demonstrated larger treatment responses than those with less severe depression.

However, treatment intensity should be considered on a case-by-case basis, according to the researchers.

“Clearly some patients will not find such interventions useful, and it would seem sensible to continue to refer severe cases to more intense psychological intervention or pharmacological management until further evidence is generated confirming our findings,” they wrote.

Disclosure: Study researcher Björn Meyer is a paid employee of GAIA AG in Hamburg, Germany, which owns one of the low-intensity interventions mentioned in the study. Bower is a paid consultant for the British Association for Counselling and Psychotherapy.