The efficacy of feedback after depression screening. A web-based randomized controlled trial

• Applicants: Professor Dr. Sebastian Kohlmann; Professor Dr. Hans-Helmut König; Professor Dr. Bernd Löwe; Professor Dr. Karl Wegscheider
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Personality Psychology, Clinical and Medical Psychology, Methodology
• Term: from 2019 to 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 424162019

• Final Report Year: 2024

Final Report Abstract

Effective depression treatments are available in the German health care system. However, most depressive disorders remain undetected and thus untreated. Internet-based depression screening combined with automated feedback of screening results could detect people with depression and lead to evidence-based care. We aimed to test the efficacy of two versions of automated feedback after internet-based screening on depression severity compared with no feedback. DISCOVER was an observer-masked, three-armed, randomised controlled trial in Germany. We recruited individuals (aged ≥18 years) who were undiagnosed with depression and screened positive for depression on an internet-based self-report depression rating scale (Pa-tient Health Questionnaire-9 [PHQ-9] ≥10 points). Participants were randomly assigned 1:1:1 to automatically receive no feedback, non-tailored feedback, or tailored feedback on the depression screening result. The non-tailored feedback included the depression screening result, a recommendation to seek professional diagnostic advice, and brief general information about depression and its treatment. The tailored feedback included the same basic information but individually framed according to the participants’ symptom profiles, treatment preferences, causal symptom attributions, health insurance, and local residence. Research staff were masked to group allocation and outcome assessment. The primary outcome was change in depression severity, defined as change in PHQ-9 score (ranging between 0 and 27 points) 6 months after random assignment. Analyses were conducted following the intention-to-treat. Between January 12, 2021, and January 31, 2022, 4.878 individuals completed the internet-based screening. Of these, 1178 (24%) screened positive for depression (mean age 37·1 [SD 14·2] years; 824 [70%] woman). Six months after random assignment, depression severity de-creased by 3,4 PHQ-9 points in the no feedback group (95% CI 2,9–4,0; within-group d 0,67; 325 participants), by 3,5 points in the nontailored feedback group (3,0–4,0; within-group d 0,74; 319 participants), and by 3,7 points in the tailored feedback group (3,2–4,3; within-group d 0,71; 321 participants), with no significant differences among the three groups (p=0,72). The number of participants seeking help for depression or initiating psychotherapy or antidepressant treatment did not differ among study groups. The results remained consistent when adjusted for fulfilling the DSM-5-based criteria for major depressive disorder or subjective belief of having a depressive disorder. Interpretation: Automated feedback following internet-based depression screening did not reduce depression severity or prompt sufficient depression care.

Publications

• The efficacy of automated feedback after internet-based depression screening: Study protocol of the German, three-armed, randomised controlled trial DISCOVER. Internet Interventions, 25, 100435.
  Sikorski, Franziska; König, Hans-Helmut; Wegscheider, Karl; Zapf, Antonia; Löwe, Bernd & Kohlmann, Sebastian
  
• (Poster). Die Wirksamkeit von automatisiertem Feedback nach internetbasiertem Depressions-Screening: Studienprotokoll des DISCOVER RCT. Deutscher Psychotherapie Kongress 2022, Berlin, Deutschland.
  Sikorski F., König H.-H., Wegscheider K., Zapf A., Löwe B. & Kohlmann S.
  
• (Poster). How individuals with undiagnosed depressive symptoms experience online depression screening: a qualitative interview study. International Society for Research on Internet Interventions Conference 2022, Pittsburgh, USA.
  Sikorski F., Löwe B. & Kohlmann S.
  
• (Vortrag). Die Wirksamkeit von automatisiertem Feedback nach internetbasiertem Depressions-Screening: Studienprotokoll des DISCOVER RCT. Deutscher Kongress für Psychosomatische Medizin und Psychotherapie 2022, Berlin, Deutschland
  Sikorski F., König H.-H., Wegscheider K., Zapf A., Löwe B. & Kohlmann S.
  
• The efficacy of automated feedback after internet-based depression screening. Study protocol of the internet-based randomized controlled trial DISCOVER (Poster, September 2022) International Society for Research on Internet Interventions Conference 2022, Pittsburgh, USA.
  Kohlmann S., Sikorski F., König H.-H., Zapf A. & Löwe B.
  
• (Mini-Talk). Hat Feedback nach Online-Depressionsscreening Nachteile? Eine Sekundäranalyse des DISCOVER RCT. Deutscher Kongress für Psychosomatische Medizin und Psychotherapie 2023, Berlin, Deutschland.
  Sikorski F., Löwe B. & Kohlmann S.
  
• How adults with suspected depressive disorder experience online depression screening: A qualitative interview study. Internet Interventions, 34, 100685.
  Sikorski, Franziska; Löwe, Bernd & Kohlmann, Sebastian
  
• How do adults with suspected depressive disorder experience online depression screening? A qualitative interview study. 10th Annual Scientific Conference of the European Association of Psychosomatic Medicine 2023, Wroclaw, Polen. (Vortrag, Juni 2023).
  Sikorski F., Löwe B. & Kohlmann S.
  
• The efficacy of automated feedback after internet-based depression screening. Preliminary results of the internet-based randomized controlled trial DISCOVER. 7th European Society for Research on Internet Interventions conference 2023, Amsterdam, Niederlande. (Vortrag, September 2023).
  Kohlmann S., Sikorski F., König H.-H., Zapf A. & Löwe B.
  
• Wie erleben Betroffene Online-Depressionsscreening? Eine qualitative Interview-Studie. Deutscher Psychotherapie Kongress 2023, Berlin, Deutschland. (Poster, Mai 2023).
  Sikorski F., Löwe B. & Kohlmann S.
  
• Cost-effectiveness of patient-tailored feedback interventions after online depression screening: Evidence from the DISCOVER trial. 16. Deutsche Gesellschaft für Gesundheitsökonomie Jahrestagung, Halle (Saale), Deutschland. (Vortrag, März 2024).
  Kreis L., König H.-H., Sikorski F., Löwe B., Kohlmann S. & Brettschneider C.
  
• Cost-effectiveness of patient-tailored feedback interventions after online depression screening: Evidence from the DISCOVER trial. European Health Economics Association Conference, Wien, Österreich. (Vortrag, Juli 2024).
  Kreis L., König H.-H., Sikorski F., Löwe B., Kohlmann S. & Brettschneider C.
  
• The efficacy of automated feedback after internet-based depression screening. Results of the internet-based randomized controlled trial DISCOVER. 7th International College of Psychosomatic Medicine Conference 2024, Tübingen, Deutschland. (Vortrag, September 2024).
  Kohlmann S., Sikorski F., König H.-H., Zapf A. & Löwe B.