Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial

Anna-Carlotta Zarski; Kiona K Weisel; Thomas Berger; Tobias Krieger; Michael P Schaub; Matthias Berking; Dennis Görlich; Corinna Jacobi; David D Ebert

doi:10.1159/000536149

Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial

Psychother Psychosom. 2024;93(3):155-168. doi: 10.1159/000536149. Epub 2024 Apr 30.

Authors

Anna-Carlotta Zarski^{1

2}, Kiona K Weisel², Thomas Berger³, Tobias Krieger³, Michael P Schaub⁴, Matthias Berking², Dennis Görlich⁵, Corinna Jacobi⁶, David D Ebert⁷

Affiliations

¹ Division of eHealth in Clinical Psychology, Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany.
² Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
³ Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
⁴ Swiss Research Institute for Public Health and Addiction (ISGF), Associated to the University of Zurich, Zurich, Switzerland.
⁵ Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
⁶ Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany.
⁷ Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany.

Abstract

Introduction: Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms.

Objective: This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC).

Methods: Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported.

Results: Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI.

Conclusions: A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.

Keywords: Internet intervention; Subclinical anxiety; Subclinical depression; Subthreshold disorders; Transdiagnostic prevention.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety / prevention & control
Anxiety / therapy
Anxiety Disorders / prevention & control
Anxiety Disorders / therapy
Cognitive Behavioral Therapy* / methods
Depression* / prevention & control
Depression* / therapy
Depressive Disorder / prevention & control
Depressive Disorder / therapy
Female
Humans
Internet
Internet-Based Intervention*
Male
Middle Aged
Mobile Applications
Telemedicine
Treatment Outcome