TY - JOUR
T1 - Guided internet interventions for depression: impact of sociodemographic factors on treatment outcome in Indonesia
AU - van der Wal, Junus M.
AU - Arjadi, Retha
AU - Nauta, Maaike H.
AU - Burger, Huibert
AU - Bockting, Claudi L. H.
PY - 2020/7
Y1 - 2020/7
N2 - Depression is the leading cause of disability worldwide, but an alarming treatment gap exists, especially in lower- and middle income countries (LMIC), where people are exposed to many societal and sociodemographic risk factors. As internet access increases in LMIC, online interventions could decrease this gap, especially when shown suitable for all demographics, including vulnerable groups with low socioeconomic status (SES). We used mixed-model analysis to explore moderating effects of sociodemographic factors (age, sex, education level, SES and urbanicity) on treatment effect in a recent trial in Indonesia, comparing guided online behavioral activation versus online psychoeducation only for depression, in 313 participants from (sub)urban areas. Outcome measures were self-reported Patient Health Questionnaire 9 (PHQ-9) and Inventory of Depressive Symptomatology (IDS-SR). Without correction for multiple testing, we found urbanicity to moderate treatment effect, with stronger treatment effect in suburban relative to urban participants (IDS-SR 24 weeks past baseline, p = 0.04) and a trend towards moderation by SES, with stronger treatment effect in low SES groups (PHQ-9 10 weeks past baseline, p = 0.07). These exploratory results suggest online treatments are a promising mental health intervention for all demographics in a (sub)urban LMIC setting, but hypothesis-testing studies including rural participants are warranted.
AB - Depression is the leading cause of disability worldwide, but an alarming treatment gap exists, especially in lower- and middle income countries (LMIC), where people are exposed to many societal and sociodemographic risk factors. As internet access increases in LMIC, online interventions could decrease this gap, especially when shown suitable for all demographics, including vulnerable groups with low socioeconomic status (SES). We used mixed-model analysis to explore moderating effects of sociodemographic factors (age, sex, education level, SES and urbanicity) on treatment effect in a recent trial in Indonesia, comparing guided online behavioral activation versus online psychoeducation only for depression, in 313 participants from (sub)urban areas. Outcome measures were self-reported Patient Health Questionnaire 9 (PHQ-9) and Inventory of Depressive Symptomatology (IDS-SR). Without correction for multiple testing, we found urbanicity to moderate treatment effect, with stronger treatment effect in suburban relative to urban participants (IDS-SR 24 weeks past baseline, p = 0.04) and a trend towards moderation by SES, with stronger treatment effect in low SES groups (PHQ-9 10 weeks past baseline, p = 0.07). These exploratory results suggest online treatments are a promising mental health intervention for all demographics in a (sub)urban LMIC setting, but hypothesis-testing studies including rural participants are warranted.
KW - Depression
KW - Dropout rates
KW - Indonesia
KW - Internet intervention
KW - Lay counsellor
KW - Lower- and middle income country
KW - Moderators
KW - Sociodemographic factors
KW - Treatment effect
UR - http://www.scopus.com/inward/record.url?scp=85082201499&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.brat.2020.103589
DO - https://doi.org/10.1016/j.brat.2020.103589
M3 - Article
C2 - 32220473
SN - 0005-7967
VL - 130
JO - Behaviour research and therapy
JF - Behaviour research and therapy
M1 - 103589
ER -