Factorial Trial Investigating Outcome and Adherence Relevant Factors in an Online Self-help Intervention for Depression (HERMES)

Factorial Trial Investigating Outcome and Adherence Relevant Factors in an Online Self-help Intervention for Depression

Multifactorial Randomised Trial Investigating Outcome and Adherence Relevant Factors in an Online Problem-solving Self-help Intervention for Mild and Moderate Depressive Symptoms

A vast amount of studies show that online interventions are suitable to reduce symptoms of mental illness as for instance depression or anxiety. However, participants who use online interventions are more likely to drop out of treatment compared to face-to-face interventions. It is important to enhance adherence to online interventions so that participants engage longer in the programs. Also, as online interventions are useful to reduce the burden of mental illness, it is of interest to further improve outcomes of such interventions. Therefore, it will be investigated in this study whether or not four different factors have an impact in fostering adherence to and improving outcome of an internet-based self-help intervention based on problem-solving therapy. A multifactorial design will be used for this study to screen simultaneously whether or not i) a diagnostic telephone interview and, ii) an educational module based on motivational interviewing prior to the intervention and iii) guidance by the study team, and iv) automated e-mail reminders during the study are active factors in enhancing adherence to and outcome of online interventions.

Participants only know that the delivery or the context of online interventions are to be improved and investigated. However, they don't know the exact interventions.

In this "arm" all four factors are set to "active" (i.e. yes): diagnostic interview motivational module guidance e-mail reminders

In this "arm" three factors are set to "active" (i.e. yes): diagnostic interview motivational module guidance

In this "arm" three factors are set to "active" (i.e. yes): diagnostic interview motivational module e-mail reminders

In this "arm" three factors are set to "active" (i.e. yes): diagnostic interview guidance e-mail reminders

In this "arm" three factors are set to "active" (i.e. yes): motivational module guidance e-mail reminders

diagnostic telephone interview (yes/no) (prior to the access to HERMES), motivational module (yes/no) (prior to the access to HERMES), guidance (yes/no) (during the usage of HERMES), e-mail reminders (yes/no) (during the usage of HERMES)

The Online Self-Help Intervention is an online program based on the problem-solving therapy (an evidence based approach of psychotherapy). All participants will receive the exact same intervention. However, what will be experimentally varied are the four listed interventions.

Assessed with the german version of Client Satisfaction Questionnaire CSQ-8 (Attkisson & Zwick, 1982)

Assessed with "Inventory for the Assessment of Negative Effects of Psychotherapy (INEP; Ladwig, Rief, & Nestoriuc, 2014)

Assessed with Working Alliance Inventory - for Internet Interventions (WAI-I; Gomez Penedo et al., 2019)

Inclusion Criteria: PHQ-9-Score between 5 - 14 Signed Informed Consent Contact information provided in case of emergency Internet connection and device to use it (Smartphone, Computer, Tablet) Fluent in german language Exclusion Criteria: Suicidal tendencies (SBQ-R > 7) a current or previous diagnose of a bipolar or psychotic disorder a current diagnosis of severe depression or another psychological disorder

Bur OT, Krieger T, Moritz S, Klein JP, Berger T. Optimizing the context of support of web-based self-help in individuals with mild to moderate depressive symptoms: A randomized full factorial trial. Behav Res Ther. 2022 May;152:104070. doi: 10.1016/j.brat.2022.104070. Epub 2022 Mar 6.

Bur OT, Krieger T, Moritz S, Klein JP, Berger T. Optimizing the Context of Support to Improve Outcomes of Internet-Based Self-help in Individuals With Depressive Symptoms: Protocol for a Randomized Factorial Trial. JMIR Res Protoc. 2021 Feb 2;10(2):e21207. doi: 10.2196/21207.