title: Effectiveness of a Novel Integrative Online Treatment for Depression (Deprexis): Randomized Controlled Trial Effect on Disability Outcomes of a Depression Relapse Prevention Program Bipolar disorder and family communication: effects of a psychoeducational treatment program. A comparative study of the impact of education vs. process groups for families of patients with affective disorders. Time to recurrence after recovery from major depressive episodes and its predictors. Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses. Delivering interventions for depression by using the internet: randomised controlled trial A randomized controlled trial of a psychoeducational group program for unipolar depression in adults in Norway (NCT00319540) Psycho-education in bipolar disorder: effect on expressed emotion Cost-Effectiveness of a Program to Prevent Depression Relapse in Primary Care Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial "Coping with depression": an open study of the efficacy of a group psychoeducational intervention in chronic, treatment-refractory depression. Expressed emotion and psychoeducational intervention for relatives of patients with schizophrenia: a randomized controlled study in Japan A psychoeducational approach to the treatment of depression: comparison of group, individual, and minimal contact procedures. A randomized trial of relapse prevention of depression in primary care. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: a randomized pilot trial.
abstract: BACKGROUND Depression is associated with immense suffering and costs , and many patients receive inadequate care , often because of the limited availability of treatment . Web-based treatments may play an increasingly important role in closing this gap between dem and and supply . We developed the integrative , Web-based program Deprexis , which covers therapeutic approaches such as behavioral activation , cognitive restructuring , mindfulness/acceptance exercises , and social skills training . OBJECTIVE To evaluate the effectiveness of the Web-based intervention in a r and omized controlled trial . METHODS There were 396 adults recruited via Internet depression forums in Germany , and they were r and omly assigned in an 80:20 weighted r and omization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual ( N = 320 ) , or to a 9-week delayed-access plus treatment-as-usual condition ( N = 76 ) . At pre- and post-treatment and 6-month follow-up , we measured depression ( Beck Depression Inventory ) as the primary outcome measure and social functioning ( Work and Social Adjustment Scale ) as the secondary outcome measure . Complete analyses and intention-to-treat analyses were performed . RESULTS Of 396 participants , 216 ( 55 % ) completed the post-measurement 9 weeks later . Available case analyses revealed a significant reduction in depression severity ( BDI ) , Cohen 's d = .64 ( CI 95 % = 0.33 - 0.94 ) , and significant improvement in social functioning ( WSA ) , Cohen 's d = .64 , 95 % ( CI 95 % = 0.33 - 0.95 ) . These improvements were maintained at 6-month follow-up . Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements ( BDI : Cohen 's d = .30 , CI 95 % = 0.05 - 0.55 ; WSA : Cohen 's d = .36 , CI 95 % = 0.10 - 0.61 ) . Moreover , a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms ( BDI : odds ratio [ OR ] = 6.8 , CI 95 % = 2.90 - 18.19 ) and recovered more often ( OR = 17.3 , 95 % CI 2.3 - 130 ) . More than 80 % of the users felt subjectively that the program had been helpful . CONCLUSIONS This integrative , Web-based intervention was effective in reducing symptoms of depression and in improving social functioning . Findings suggest that the program could serve as an adjunctive or st and -alone treatment tool for patients suffering from symptoms of depression Objective This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse . Material s and Methods Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription . Patients responding to initial treatment but at high risk for relapse were r and omized to usual care or a relapse prevention intervention ( N = 386 ) . The 12-month relapse prevention program included systematic patient education , two psycho-educational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail .  Disability outcomes were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months using SF-36 and Sheehan Disability scales . Results Usual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy . Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period . One of the three disability measures ( the SF-36 Social Function scale ) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up , whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls . Conclusions Moderate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes . Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients , relatively mild levels of depressive symptoms among both intervention and control patients at baseline , the absence of a specific relapse prevention effect of the intervention , and the result ant modest differences in depressive symptoms between intervention and control patients in this trial Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders , but little is known about what these programs change about families . The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy ( FFT ; n = 22 ) or crisis management with naturalistic follow-up ( CMNF ; n = 22 ) , both administered with maintenance pharmacotherapy . Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF , although no corresponding decreases were seen in negative interactional behaviors . The positive effect of family treatment on patients ' symptom trajectories over 1 year was partially mediated by increases in patients ' positive nonverbal interactional behaviors during this same interval This clinical project compares the relative impact of two types of multiple family groups on psychiatric in patients and their families . Forty patients with a diagnosis of affective disorder , and their family members , were r and omly assigned to a traditional multiple family group with a process orientation that emphasized support , destigmatization , and self-help about common problems ; or to a psychoeducational multiple family group that emphasized the provision of information about the patient 's illness and methods of coping with it effectively . Both groups , which met for four hours on a Saturday afternoon , were an integral part of an ongoing inpatient program specializing in the treatment of affective disorders . Pre- and post- measures were obtained regarding family and patient knowledge about affective disorders , level of personal distress , attitudes about the illness , and dyadic adjustment . In addition , both patients and family members were asked to rate their satisfaction with the group experience . A number of differences in knowledge , attitude and dyadic adjustment were found in the participants of both groups immediately following their respective group sessions , but there were only a few statistically significant differences between the two groups . Those who attended the psychoeducational session , however , reported significantly more satisfaction with the experience BACKGROUND Depression is a remitting but recurring disease . However , there is a paucity of prospect ively recorded data on the course of depression after recovery . METHOD A multi-centre prospect i ve serial follow-up study of an inception cohort of hitherto untreated unipolar major depression ( N = 95 ) for 6 years . We report the time to recurrence after recovery from the index depressive episode and their predictors . RESULTS The cumulative probability of remaining well without subthreshold symptoms was 57 % ( 95 % CI , 46 to 68 % ) at 1 year , 47 % ( 95 % CI , 36 to 58 % ) at 2 years and 35 % ( 95 % CI , 23 to 47 % ) at 5 years . The same without full relapse was 79 % ( 95 % CI , 70 to 88 % ) at 1 year , 70 % ( 95 % CI , 60 to 80 % ) at 2 years and 58 % ( 95 % CI , 46 to 70 % ) at 5 years . The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19 - 0 months ( 95 % CI , 2 - 4 to 35 - 7 ) , and that to the end of the full episode was over 6 years . Residual symptoms at time of recovery predicted earlier recurrence . CONCLUSIONS The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients . However , the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode The relative benefit of adding a structured psychoeducational intervention to st and ard medication treatment for married patients with bipolar disorder and their spouses was assessed . Patients were r and omly assigned to receive either medication management or medication management plus a marital intervention with their spouses for an 11-month period . Patients '  symptoms , functioning , and adherence to their medication regimens were measured at study entry and at 11 months . Significant effects favoring the combined treatments were observed for overall patient functioning but not for symptom levels . The marital intervention was associated with improved medication adherence . Combined psychosocial and medication treatment does not affect patients ' symptom levels beyond the effects of medication alone , but it does result in significant incremental gains in overall patient functioning Abstract Objective To evaluate the efficacy of two internet interventions for community-dwelling individuals with symptoms of depression — a psychoeducation website offering information about depression and an interactive website offering cognitive behaviour therapy . Design R and omised controlled trial . Setting Internet users in the community , in Canberra , Australia . Participants 525 individuals with increased depressive symptoms recruited by survey and r and omly allocated to a website offering information about depression ( n = 166 ) or a cognitive behaviour therapy website ( n = 182 ) , or a control intervention using an attention placebo ( n = 178 ) . Main outcome measures Change in depression , dysfunctional thoughts ; knowledge of medical , psychological , and lifestyle treatments ; and knowledge of cognitive behaviour therapy . Results Intention to treat analyses indicated that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample . For the intervention that delivered cognitive behaviour therapy the reduction in score on the depression scale of the Center for Epidemiologic Studies was 3.2 ( 95 % confidence interval 0.9 to 5.4 ) . For the “ depression literacy ” site ( BluePages ) , the reduction was 3.0 ( 95 % confidence interval 0.6 to 5.2 ) . Cognitive behaviour therapy ( MoodGYM )  reduced dysfunctional thinking and increased knowledge of cognitive behaviour therapy . Depression literacy ( BluePages ) significantly improved participants ' underst and ing of effective evidence based treatments for depression ( P < 0.05 ) . Conclusions Both cognitive behaviour therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression Background Coping with  Depression Course ( CWD ) has shown to be effective in the treatment of depression . However , there are very few r and omized controlled trials on unipolar depression in adults Aims To test the effect of a modified CWD on unipolar depression in a r and omized controlled trial design in adults . Methods Participants were recruited through mass media , tested by BDI and clinical interview , and r and omized into intervention group ( N = 81 ) and control group ( N = 74 ) . The program was mainly conducted by nurses with background in psychiatry and primary health care , and the intervention encompassed 8 weekly sessions of 2 1/2 hours , with 3 booster sessions . Results By " intention-to-treat " analysis a statistically significant effect on depressive symptoms at follow up at 6 months was found , and the level of symptoms was sustained after 12 months . Conclusion The study shows that the intervention is effective in the treatment of unipolar depression , and suitable for specialized psychiatric services as well as primary health care In a waiting-list controlled study on a multi-family psycho-educational intervention in bipolar disorder , key relatives in the treatment group showed a significant change from high to low levels of expressed emotion ( EE ) compared with the control group . In addition , patients with low-EE key relatives had a significantly lower number of hospital admissions compared with those living with high-EE key relatives . The multi-family groups were well received by the participants , and there were only a few drop-outs Objective . Evaluate the incremental cost-effectiveness of a  depression relapse prevention program in primary care Material s and Methods . Primary care patients initiating antidepressant treatment completed a st and ardized telephone assessment 6–8 weeks later . Those recovered from the current episode but at high risk for relapse ( based on history of recurrent depression or dysthymia ) were offered r and omization to usual care or a relapse prevention intervention . The intervention included systematic patient education , two psychoeducational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and telephone and mail monitoring of medication adherence and depressive symptoms . Outcomes in both groups were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months and health plan cl aims and accounting data . Results . Intervention patients experienced 13.9 additional depression-free days during a 12-month period ( 95 % CI , −1.5 to 29.3 ) . Incremental costs of the intervention were $ 273 ( 95 % CI , $ 102 to $ 418 ) for depression treatment costs only and $ 160 ( 95 % CI , −$173 to $ 512 ) for total outpatient costs . Incremental cost-effectiveness ratio was $ 24 per depression-free day ( 95 % CI , −$59 to $ 496 ) for depression treatment costs only and $ 14 per depression-free day ( 95 % CI , −$35 to $ 248 ) for total outpatient costs . Conclusions . A program to prevent depression relapse in primary care yields modest increases in days free of depression and modest increases in treatment costs . These modest differences reflect high rates of treatment in usual care . Along with other recent studies , these findings suggest that improved care of depression in primary care is a prudent investment of health care re sources Abstract Objectives : To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness , symptoms , and subjective function . Design : A pragmatic multicentre r and omised controlled trial , stratified by centre . Setting : Nine urban and rural communities in Finl and , Republic of Irel and , Norway , Spain , and the United Kingdom . Participants : 452 participants aged 18 to 65 , identified through a community survey with depressive or adjustment disorders according to the international classification of diseases , 10th revision or Diagnostic and Statistical Manual of Mental Disorders , fourth edition . Interventions : Six individual sessions of problem solving treatment ( n=128 ) , eight group sessions of the course on prevention of depression ( n=108 ) , and controls ( n=189 ) . Main outcome measures : Completion rates for each intervention , diagnosis of depression , and depressive symptoms and subjective function . Results : 63 % of participants assigned to problem solving and 44 % assigned to prevention of depression completed their intervention . The proportion of problem solving participants depressed at six months was 17 % less than that for controls , giving a number needed to treat of 6 ; the mean difference in Beck depression inventory score was −2.63 ( 95 % confidence interval −4.95 to −0.32 ) , and there were significant improvements in SF-36 scores . For depression prevention , the difference in proportions of depressed participants was 14 % ( number needed to treat of 7 ) ; the mean difference in Beck depression inventory score was −1.50 ( −4.16 to 1.17 ) , and there were significant improvements in SF-36 scores . Such differences were not observed at 12 months . Neither specific diagnosis nor treatment with antidepressants affected outcome . Conclusions : When offered to adults with depressive disorders in the community , problem solving treatment was more acceptable than the course on prevention of depression . Both interventions reduced caseness and improved subjective function BACKGROUND Failure to respond to antidepressant medication represents a major clinical problem . Few therapeutic interventions have been shown to benefit such individuals . METHOD Patients attended a 12-session psychoeducational programme over a period of 10 weeks , with follow-up at 26 weeks . The main outcome measures were the self-report Beck Depression Inventory ( BDI-II ) , the Global Severity Index ( GSI ) of the Brief Symptom Inventory ( BSI ) and the EuroQol 5D . RESULTS Baseline assessment s confirmed substantial chronicity and treatment resistance , high symptom burden and poor quality of life in the study cohort . Twenty-six week follow-up data were obtained from 34 % of cohort . Completion of the course was associated with clinical ly significant changes in symptom burden . Sustained remission was achieved by 35 % of completers . LIMITATIONS We did not characterise the cohort using structured clinical interview and did not collect structured , objective ratings of mental health status . There was no control group . There was a high attrition rate and caution must be exercised in interpreting results . CONCLUSIONS For a proportion of patients with chronic depressive episodes that have not responded to  antidepressant treatments  , the " Coping with Depression " psychoeducational group may confer sustained and meaningful benefit . Controlled studies are warranted The benefit of single-family treatment ( SFT ) in addition to short educational sessions ( SES ) consisting of multiple-family treatment was investigated . The study design was a r and omized controlled study . Subjects were 30 patients suffering from schizophrenia with at least one of their family members showing high expressed emotion ( EE ) in the Camberwell Family Interview . After the SES , the patients were r and omly allocated to two groups : those who received routine individual outpatient treatment and those who received additional SFT and routine treatment . The two groups were followed for 9 months after discharge , and the relapse risks were compared . The relapse risk was lower in the SES+SFT group than in the SES group ( 23.1 % vs. 35.3 % ) . However , the difference was not significant . When high-EE families were classified into those with many critical comments ( high-CC ) or a high score of emotional overinvolvement ( high-EOI ) , the relapse risk was 0 % in the patients living with a high-CC family not only in the SES+SFT group but also in SES group . In the patients living with a high-EOI family , the relapse risk was lower in the SES+SFT group than in the SES group ( 42.9 % vs. 60.0 % ) . These findings suggest that high-EE families should receive at least SES , and additional SFT should be given to families with specific needs This study examined the efficacy of a psychoeducational approach in treating unipolar depression . The vehicle of treatment was a course in " Coping with Depression . " An explicit educational experience , the course addressed several specific target behaviors ( social skills , thinking , pleasant activities , and relaxation ) as well as more general components hypothesized to be critical to successful cognitive-behavioral therapy for depression . Sixty-three individuals who met Research Diagnostic Criteria ( RDC ) for unipolar depression were r and omly assigned to one of four conditions : class , individual tutoring , minimal contact , or delayed treatment control . Participants in the immediate treatment conditions were assessed pre- and posttreatment and at 1- and 6-month follow-up sessions ; the delayed treatment group was assessed prior to and following an 8-week waiting period . Results indicated clinical improvement by all of the active treatment conditions compared to the delayed treatment condition . Differences between active treatment conditions were small , and some differences between high and low responders to treatment were found . Results are discussed in terms of their implication s for future clinical use of this approach . Stimulated by recent theoretical developments , there has been an impressive proliferation of interventions and approaches for the psychological treatment of unipolar depression . Treatments derived from cognitive positions have been aim ed at depressive thought processes ( e.g. , Beck , Rush , Shaw , & Emery , 1979 ; Fuchs & Rehm , 1977 ) , whereas those derived from behavioral positions have been aim ed at the improvement of social skills ( Hersen , Bellack , & Himmelhoch , 1980 ; Sanchez , Lewinsohn , & Larson , 1980 ; Zeiss , 1977 ) , at increasing pleasant activities and time management relaxation skills ( Lewinsohn , 1977 ) , and at more general problemsolving skills ( McLean & Hakstian , 1979 ) . BACKGROUND Despite high rates of relapse and recurrence , few primary care patients with recurrent or chronic depression are receiving continuation and maintenance-phase treatment . We hypothesized that a relapse prevention intervention would improve adherence to antidepressant medication and improve depression outcomes in high-risk patients compared with usual primary care . METHODS Three hundred eighty-six patients with recurrent major depression or dysthymia who had largely recovered after 8 weeks of antidepressant treatment by their primary care physicians were r and omized to a relapse prevention program ( n = 194 ) or usual primary care ( n = 192 ) . Patients in the intervention group received 2 primary care visits with a depression specialist and 3 telephone visits over a 1-year period aim ed at enhancing adherence to antidepressant medication , recognition of prodromal symptoms , monitoring of symptoms , and development of a written relapse prevention plan . Follow-up assessment s were completed at 3 , 6 , 9 , and 12 months by a telephone survey team blinded to r and omization status . RESULTS Those in the intervention group had significantly greater adherence to adequate dosage of antidepressant medication for 90 days or more within the first and second 6-month periods and were significantly more likely to refill medication prescriptions during the 12-month follow-up compared with usual care controls . Intervention patients had significantly fewer depressive symptoms , but not fewer episodes of relapse/recurrence over the 12-month follow-up period . CONCLUSIONS A relapse prevention program targeted to primary care patients with a high risk of relapse/recurrence who had largely recovered after antidepressant treatment significantly improved antidepressant adherence and depressive symptom outcomes BACKGROUND Studies on individual psychotherapy indicate that some interventions may reduce the number of recurrences in bipolar patients . However , there has been a lack of structured , well- design ed , blinded , controlled studies demonstrating the efficacy of group psychoeducation to prevent recurrences in patients with bipolar I and II disorder . METHODS One hundred twenty bipolar I and II out patients in remission ( Young Mania Rating Scale score < 6 , Hamilton Depression Rating Scale-17 score < 8) for at least 6 months prior to inclusion in the study , who were receiving st and ard pharmacologic treatment , were included in a controlled trial . Subjects were matched for age and sex and r and omized to receive , in addition to st and ard psychiatric care , 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings . Subjects were assessed monthly during the 21-week treatment period and throughout the 2-year follow-up . RESULTS Group psychoeducation significantly reduced the number of relapsed patients and the number of recurrences per patient , and increased the time to depressive , manic , hypomanic , and mixed recurrences . The number and length of hospitalizations per patient were also lower in patients who received psychoeducation . CONCLUSION Group psychoeducation is an efficacious intervention to prevent recurrence in pharmacologically treated patients with bipolar I and II disorder This r and omized pilot study investigated the effects of meditation with yoga ( and psychoeducation ) versus group therapy with hypnosis ( and psychoeducation ) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders . Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up . Eight hypnosis group participants also experienced a remission , but the difference from controls was not statistically significant . Three control participants , but no meditation or hypnosis participants , developed a new depressive episode during the study , though this difference did not reach statistical significance in any case . Although all groups reported some reduction in symptom levels , they did not differ significantly in that outcome . Overall , these results suggest that these two interventions show promise for treating low- to moderate-level depression
target: Conclusions : Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy .
  However , there are only a few studies regarding its effectiveness on adult patients with major depressive disorder .
  Although the publications in this area are still very limited , the articles selected in this review suggest that psychoeducation is effective in improving the clinical course , treatment adherence , and psychosocial functioning of depressive patients
background: Objective : Pharmacological treatment is considered indispensable to major depressive disorder .
  In spite of this , a significant number of patients do not respond adequately to treatment based only on medication , presenting high relapse and recurrence rates .
  Therefore , psychosocial interventions , such as psychoeducation , have been increasingly recognized as an essential component in the treatment of depression , associated with pharmacological strategies .
  Thus , the aim of the present systematic review was to evaluate the effectiveness of psychoeducation  for patients with unipolar depression , analyzing the evidence from the literature .