Moodbuster, a Guided Self-help Intervention for Prevention of Depression in Primary Care

Depression is a common, often recurring, condition and the leading cause of disability worldwide. In the UK, the one-week prevalence of depression is estimated at 3.3%, and by 2026, the cost of depression to the UK economy is estimated to reach £12.15 billion in lost earnings and service use costs. There are two main strategies to reduce the burden of depression, treatment and prevention. Treatment for depression is, even with full coverage of services to all those who need it, not enough.to avert the total burden of disease. Indeed, whist treatment is crucial, even if all people with depression received evidence-based treatment, it is likely that only 35% of the burden (years lived with disabilities) would be averted. Prevention strategies are an integral part of reducing the burden of depression through fully preventing, or otherwise delaying, its onset. One way to improve the reach of prevention interventions and to deliver such approaches at scale is to offer interventions via digital technologies such as websites, computer programmes, or apps. This allows for a larger reach and it may help reach communities which are currently under-served by traditional mental health services. Whilst digital tools have been shown to be effective and acceptable in primary care for the treatment of depression, less research has been conducted on its effectiveness or barriers and facilitators to implementation for prevention. A 2017 meta-analysis identified ten trials on the effectiveness of digital interventions for the prevention of anxiety and depression. The review found promising evidence for the use of digital interventions for prevention, finding a small but positive effect on depression symptoms in the short-term (0.25, [0.09-0.41], p = 0.003). However, the majority of these studies were conducted outside of the UK, in Germany, Australia, USA, Japan, Norway, and the Netherlands. The trials also represented a mix of universal interventions, and indicated/selective efforts targeted to university students, older adults, and young adults. Of the two studies identified that were conducted in the UK, both had a short-term follow up, one of 6 weeks, and the other 12 weeks and did not include diagnostic outcome assessments. This suggests there is still more to learn about the application of digital technologies in the UK for the prevention of depression, and the medium to longer term effects of such interventions.

Research questions:

1. Can an online self-help tool reduce depression symptoms and help support the prevention of depression?
2. What are the effects of Moodbuster on the development of depression, anxiety symptoms, quality of life, and service use, and are there any negative unintended effects?
3. What are the barriers and facilitators to implementing an online tool for prevention in primary care and community settings?

Research hypothesis:

It is hypothesised that the intervention group will display reduced depression symptoms and incidence, reduced service use, and improved quality of life, and the intervention will be acceptable to a UK primary care population.