The long shadow of early-change patterns: a 3-year follow-up after the use of a web-based intervention for mild to moderate depressive symptoms

Edelbluth, Susanne; Klein, Jan Philipp; Schwartz, Brian; Hehlmann, Miriam; Arndt, Alice; Rubel, Julian; Moggia, Danilo; Berger, Thomas; Meyer, Björn; Moritz, Steffen; Schröder, Johanna; Lutz, Wolfgang (2024). The long shadow of early-change patterns: a 3-year follow-up after the use of a web-based intervention for mild to moderate depressive symptoms. Cognitive behaviour therapy, pp. 1-20. Routledge, Taylor & Francis Group 10.1080/16506073.2024.2368520

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Web-based interventions can be effective in treating depressivesymptoms. Patients with risk not responding to treatment havebeen identified by early change patterns. This study aims to examinewhether early changes are superior to baseline parameters in pre-dicting long-term outcome. In a randomized clinical trial with 409individuals experiencing mild to moderate depressive symptomsusing the web-based intervention deprexis, three latent classeswere identified (early response after registration, early responseafter screening and early deterioration) based on early change inthe first four weeks of the intervention. Baseline variables and theseclasses were included in a Stepwise Cox Proportional Hazard MultipleRegression to identify predictors associated with the onset of remis-sion over 36-months. Early change class was a significant predictor ofremission over 36 months. Compared to early deterioration afterscreening, both early response after registration and after screeningwere associated with a higher likelihood of remission. In sensitivityand secondary analyses, only change class consistently emerged asa predictor of long-term outcome. Early improvement in depressionsymptoms predicted long-term outcome and those showing earlyimprovement had a higher likelihood of long-term remission. Thesefindings suggest that early changes might be a robust predictor forlong-term outcome beyond baseline parameters.

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